Pleural homocysteine for malignant pleural effusion: A prospective and double‐blind diagnostic test accuracy study

Cao, Xi‐Shan; Zhao, Wen; Wen, Xu‐Hui; Han, Yu‐Ling; Li, Yan; Jiang, Ting-Wang; Huang, Jin-Hong; Chen, Hong; Zheng, Wen‐Qi; Hu, Zhide

doi:10.1111/1759-7714.14570

Cited by 6 publications

(3 citation statements)

References 38 publications

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“…The diagnostic criteria for MPE were effusion cytology or pleural biopsy, or evidence of a primary tumor and other benign pleural effusion (BPE) can be excluded by treatment response or follow‐up. The diagnostic criteria for BPE have been introduced in our previous studies 30,32,33 …”

Section: Methodsmentioning

confidence: 99%

Long‐term stability of pleural fluid carcinoembryonic antigen and its effect on the diagnostic accuracy for malignant pleural effusion

et al. 2023

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Background: The in vitro stability assessment is essential for investigating the diagnostic accuracy of pleural biomarkers. This study aimed to investigate the long-term stability of pleural fluid carcinoembryonic antigen (CEA) at À80 C to À70 C. In addition, we analyzed the effects of frozen storage on the diagnostic accuracy of CEA for malignant pleural effusion (MPE). Methods: Pleural fluid CEA of participants in two prospective cohorts were stored at À80 C to À70 C for 1-3 years. The CEA level in the stored specimen was measured with an immunoassay, and its level in the fresh specimen was extracted from medical records. The Bland-Altman method, Passing-Bablok regression, and Deming regression were used to analyze the agreement of CEA between the fresh and frozen pleural fluid. In addition, we used receiver operating characteristic (ROC) curves to evaluate the diagnostic accuracy of CEA in the fresh and frozen specimens for MPE. Results: A total of 210 participants were enrolled. The median CEA levels in frozen and fresh pleural fluid specimens were similar (frozen, 2.32 ng/mL; fresh, 2.59 ng/mL; p < 0.01). The slopes and intercepts in the Passing-Bablok regression (intercept 0.01, slope 1.04) and Deming regression (intercept 0.65; slope 1.00) were not statistically significant (p > 0.05 for all). No significant difference was observed between the area under the ROC curves of CEA in the fresh and frozen specimens (p > 0.05 for all). Conclusion: Pleural fluid CEA is seemingly stable when stored at -80 C to À70 C for 1-3 years. Frozen storage does not significantly affect the diagnostic accuracy of CEA for MPE.

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Section: Methodsmentioning

confidence: 99%

Long‐term stability of pleural fluid carcinoembryonic antigen and its effect on the diagnostic accuracy for malignant pleural effusion

et al. 2023

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“…This study included two cohorts, named the SIMPLE cohort and the BUFF cohort. The SIMPLE (A S tudy I nvestigating M arkers in PL eural E ffusion) is a prospective, double-blind diagnostic test accuracy study, and its design details have been described previously [ 18 , 19 ]. In brief, patients who visited the Affiliated Hospital of Inner Mongolia Medical University (AHIMMU) with undiagnosed PE between September 2018 and July 2021 were prospectively enrolled.…”

Section: Methodsmentioning

confidence: 99%

Age affects the diagnostic accuracy of the cancer ratio for malignant pleural effusion

Huang¹,

Chen²,

Gu³

et al. 2023

BMC Pulm Med

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Background and objective Cancer ratio (CR), which is defined as serum lactate dehydrogenase (LDH) to pleural fluid adenosine deaminase (ADA) ratio, has been reported to be a useful diagnostic marker for malignant pleural effusion (MPE). Whether its diagnostic accuracy is affected by age remains unknown. This study aimed to investigate the effects of age on the diagnostic accuracy of CR. Methods The participants in this study were from a prospective cohort (SIMPLE cohort, n = 199) and a retrospective cohort (BUFF cohort, n = 158). All participants were patients with undiagnosed pleural effusion (PE). We used receiver operating characteristic (ROC) curves to evaluate the diagnostic accuracy of CR. The effect of age on the diagnostic accuracy of CR was investigated by adjusting the upper limit of age for participant enrolment. Results Eighty-eight MPE patients were verified in the SIMPLE cohort, and thirty-five MPE patients were verified in the BUFF cohort. The AUCs of CR in the SIMPLE and BUFF cohorts were 0.60 (95% CI: 0.52–0.68) and 0.63 (95% CI: 0.54–0.71), respectively. In both cohorts, the AUCs of CR decreased with the advancement of age. Conclusion Age can affect the diagnostic accuracy of CR for MPE. CR has limited diagnostic value in older patients. Key message Cancer ratio is a promising diagnostic marker for malignant pleural effusion. This study revealed that its diagnostic accuracy decreased in older patients. Its diagnostic accuracy is overestimated by previous studies using tuberculosis and pneumonia patients as controls.

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“…The participants in this work were from the SIMPLE (a S tudy I nvestigating M arkers in PL eural E ffusion) study, a pre-registered, double-blind prospective diagnostic test accuracy study. 33,34 Briefly, we recruited the pleural effusion patients who visited the Affiliated Hospital of Inner Mongolia Medical University (AHIMMU) between September 2018 and July 2021 (Hohhot cohort). In June 2020, we enrolled the participants in the Affiliated Changshu Hospital of Nantong University (formerly the Affiliated Changshu Hospital of Xuzhou Medical University, ACHXMU) (Changshu cohort).…”

Section: Methodsmentioning

confidence: 99%

Value of human epididymis secretory protein 4 in differentiating malignant from benign pleural effusion: an analysis of two cohorts

Yang,

Niu,

Wen

et al. 2023

Ther Adv Respir Dis

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Background: Lung cancer is the most common cause of malignant pleural effusion (MPE). Serum human epididymis secretory protein 4 (HE4) is a useful diagnostic marker for lung cancer. Objective: This study aimed to evaluate the diagnostic accuracy of pleural fluid HE4 for MPE. Design: A prospective, double-blind diagnostic test accuracy study. Methods: Patients with undiagnosed pleural effusion were enrolled in two cohorts (Hohhot and Changshu). Electrochemiluminescence immunoassay was used to detect pleural fluid HE4. The diagnostic accuracy of HE4 was evaluated by a receiver operating characteristic (ROC) curve, and the net benefit of HE4 was assessed by a decision curve analysis (DCA). Results: A total of 66 MPEs and 86 benign pleural effusions (BPEs) were enrolled in the Hohhot cohort. In the Changshu cohort, 26 MPEs and 32 BPEs were enrolled. In both cohorts, MPEs had significantly higher pleural fluid HE4 than BPEs. The area under the ROC curve (AUC) of HE4 was 0.73 (95% CI: 0.64–0.81) in the Hohhot cohort and 0.79 (95% CI: 0.67–0.91) in the Changshu cohort. At a threshold of 1300 pmol/L, HE4 had sensitivities of 0.44 (95% CI: 0.33–0.56) in the Hohhot cohort and 0.54 (95% CI: 0.35–0.73) in the Changshu cohort. The corresponding specificities were 0.90 (95% CI: 0.83–0.95) in the Hohhot cohort and 0.94 (95% CI: 0.84–1.00) in the Changshu cohort. In subgroup analyses, HE4 had an AUC (95% CI) of 0.78 (0.71–0.85) in exudates and an AUC of 0.69 (0.57–0.81) in patients with negative effusion cytology. The DCA revealed that HE4 determination had a net benefit in both cohorts. Conclusion: Pleural fluid HE4 has moderate diagnostic accuracy for MPE and has net benefit in pleural effusion patients with unknown etiology.

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Pleural homocysteine for malignant pleural effusion: A prospective and double‐blind diagnostic test accuracy study

Cited by 6 publications

References 38 publications

Long‐term stability of pleural fluid carcinoembryonic antigen and its effect on the diagnostic accuracy for malignant pleural effusion

Long‐term stability of pleural fluid carcinoembryonic antigen and its effect on the diagnostic accuracy for malignant pleural effusion

Age affects the diagnostic accuracy of the cancer ratio for malignant pleural effusion

Value of human epididymis secretory protein 4 in differentiating malignant from benign pleural effusion: an analysis of two cohorts

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