Carcinoembryonic antigen in fine-needle aspirate of liver: a diagnostic adjunct to cytology

CA-125 in fine-needle aspirates of solid tumors: comparison with cytologic diagnosis and carcinoembryonic antigen (CEA) assay

One hundred and twenty-two fine needle aspirates (FNA) from female patients were studied to determine whether CA-125 assay contributed to cytologic diagnosis and CEA assay. Cytologic examination was done on Papanicolaou-stained smears and cell blocks, CEA by EIA (Abbott Laboratory, > 5 ng/ml cutoff) and CA-125 by RIA (Abbott Laboratory, North Chicago, IL, > 66 mu/ml cutoff). Final diagnosis were correlated with histologic diagnosis when available, clinical, radiologic studies, and follow-up.

RESULTS

29 benign, 93 malignant. Sensitivities and specificities: cytology, 91%, 100%; CEA: 59%, 86%; CA-125, 50%, 55%. CEA plus cytology sensitivity, 97%. CA-125 content was highest in endometrial/ovarian carcinoma (39,899 mu/ml) and < 5,000 mu/ml in other tumors and benign FNA in contrast to CEA which showed highest levels in carcinomas of colon, pancreas, and lung (> 280 ng/ml). While elevated CEA enhances the sensitivity of cytologic diagnosis of carcinomas of the colon, pancreas, and lung, low CEA and high CA-125 content supports an ovarian/endometrial primary.

Carcinoembryonic antigen assay of intra-abdominal fine-needle aspirates

Differentiating abscesses from necrotic tumors has important therapeutic implications. Currently, cytologic examination is the "gold standard," but it has a low sensitivity for cystic/necrotic tumors. To address this problem, a prospective study was conducted comparing the results of cytologic examination with those of carcinoembryonic antigen (CEA) immunoassay of fine-needle aspirates in 24 patients undergoing radiologically or surgically guided fine-needle aspiration. Of 26 fine-needle aspirates, 20 were malignant and 6 benign. Final results were correlated with pathologic examination (when available), clinical review, and follow-up. Three patients had an abscess associated with perforated, recurrent carcinoma, of whom only one had cytologic assessment prior to drainage. The sensitivity of fine-needle aspiration was 85%, and for adenocarcinoma alone, 80%. CEA sensitivity (greater than 5 ng/mL) was 50%, and for adenocarcinoma, 90%; the specificity of the assay was 64%. A high CEA level alone was diagnostic of metastatic carcinoma of the colon in two fine-needle aspirates. Cytologic assessment and CEA assay of fine-needle aspirates and cyst/abscess drainage facilitate the diagnosis of unsuspected adenocarcinoma.