Value of serum and effusion fluid CEA levels for distinguishing between diffuse malignant mesothelioma and carcinomatous pleural metastases

Abstract

Differentiation of diffuse malignant mesothelioma (DMM) from pleural carcinomatous metastases, e.g., of lung cancer (LC) may be difficult both for the clinician and the pathologist [1, 2] because of the limited diagnostic accuracy of radiologic criteria and conventional light microscopy including histochemistry [3,4]. Immunohistochemical detection of carcinoembryonic antigen (CEA) in tumor biopsy material has been shown to be a valuable diagnostic adjunct, as DMMs, unlike LCs and other carcinomas, express this antigen only rarely (9-11%) [5]. In some cases, however, the only method of obtaining suitable biopsy material is by open thoracotomy [2, 6]. Moreover, immunohistochemical examinations are expensive and not generally readily available. We therefore decided to find out what conclusions may be drawn from the much simpler determination of CEA levels in serum and in pleural effusion fluid (EF).We measured CEA in serum and EF using our own, and five commercially available radioimmunoassays or enzyme immunoassays (Abbott, Behringwerke, CIS, Roche, Pharmacia) with a serum level of 3 mg/L as the upper limit of reference values. In an initial partly retrospective study (learning phase), we examined patients with histologically proven DMM (n = 94) or LC (n = 79). Using ROC analysis, cutoff levels (serum CEA: 5.2 rag/L, EF CEA: 4.5 mg/L) were set so as to produce the most statistically significant differentiation (x2-test) between DMM and LC ( Table 1). The discrimination values specified and published [7] after the learning phase were then evaluated in a strictly prospective fashion in two additional sets of patients. From 1991 to 1992, we determined serum and EF CEA levels in 146 patients participating in the multicentric German DMM study, in all of whom the diagnosis of DMM had been reviewed by a panel of experienced pathologists. For comparison, we analyzed 124 patients who had presented with pleural effusions of unknown aetiology and had subsequently been shown to be suffering from metastatic carcinoma. There was a statistically significant difference between the DMM and the metastatic carcinoma group in terms of the frequency of elevated CEA levels (x2-test, p < 0.01) ( Table I). These results show that simple determination of CEA provides information that is useful for distinguishing between DMM

Evaluation of seven tumour markers in pleural fluid for the diagnosis of malignant effusions

“…In malignant effusions, comparative analysis highlighted the similar diagnostic performances of CEA, CA 72-4, CA 15-3 and CYFRA, clearly superior to those of CA 19-9, NSE and SCC. The diagnostic sensitivity for pleural CEA was concordant with those described in previous studies, confirming its utility in carcinomas (Rapellino et al, 1990) and its non-expression in mesotheliomas (Mezger et al, 1994). Few studies on pleural fluid have integrated CA 72-4 (Ferroni et al, 1990, Villena et al, 1996 and our results confirmed the high sensitivity of CA 72-4 in all types of adenocarcinomas, but we also noted high levels in squamous cell carcinomas.…”

Diagnostic utility of CYFRA 21-1, carcinoembryonic antigen, CA 125, neuron specific enolase, and squamous cell antigen level determinations in the serum and pleural fluid of patients with pleural effusions

“…5,22 An interesting use of CEA is the differentiation between pleural effusions due to metastatic and malignant mesothelioma. Faravelli et al reported that pleural effusions secondary to a metastatic malignancy have higher CEA levels in the pleural fluid 23 than those due to malignant mesothelioma, and Mezger et al 24 found the same to be true in serum. The results of the current study, although occurring in a small number of patients, confirm these data and support the suggestion that CEA determination in serum and pleural fluid may be a complementary tool to immunohistochemical studies for differentiating pleural effusions due to metastatic tumors from malignant mesothelioma.…”

Diagnostic Value Of CEA, CA-19-9, CA 125 And CA 15-3 Levels In Malignant Pleural Fluids

“…Several investigators highlighted that determination of tumor marker levels might be useful in distinguishing the type of cancer. Wagner et Faravelli, found CA 15-3 level to be higher in patients with metastatic cancer compared to that of mesothelioma cases (17,18). While Porcel et al, found CEA level showing an increase of 59% in lung cancer and 71% in gastrointestinal cancer cases, they determined CA-125 level in patients with ovarium cancer as 67%.…”