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El-Kalashy MM, Eid HA, Awad SM, Allam ET, Hassan RAA, El-Koa AA. Role of GSDMD and VEGF in differentiating between malignant and non-malignant pleural effusions. BENI-SUEF UNIVERSITY JOURNAL OF BASIC AND APPLIED SCIENCES 2023. [DOI: 10.1186/s43088-023-00366-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Abstract
Background
It is crucial to differentiate between benign and malignant pleural effusions while making a diagnosis. The purpose of this research was to investigate the diagnostic significance of GSDMD and VEGF in discriminating between different kinds of pleural effusion and their correlation with both progression-free and overall survivals in the malignant type.
Methods
Ninety-one pleural fluid samples, which were classified as transudates or exudates (tuberculous, para-infectious, or malignant) by pleural fluid classifications, were tested for GSDMD using sandwich ELIZA kits, and 41 of the exudative samples were randomly selected for VEGF testing. Both markers' diagnostic accuracy was assessed.
Results
The lowest level of GSDMD was associated with the transudate group (mean and SD of 2.35 ± 0.44 ng/mL) and the highest in the malignant effusion group (mean and SD of 4.38 ± 1.67 ng/mL). The specificity and sensitivity of GSDMD in the diagnosis of exudative PE were 97% and 98%, respectively (p = 0.001) with the cutoff point = 2.89). Regarding VEGF, its level was 222.3 ± 53.4 pg/ml for all studied samples where MPE (n = 21) was 261.2 ± 48.2 pg/ ml (mean ± SD), TBPE (n = 7) was 185.4 ± 6.96 pg/ml (mean ± SD), and PIPE (n = 13) was 179.3 ± 13.9 pg/ml (mean ± SD). The diagnostic accuracy of VEGF for the detection of MPE was 90% with a sensitivity of 100% and specificity of 80% and the cutoff point was 191.5 pg/ml. There were highly significant inverse correlations between progression-free survival and both GSDMD (r =− 0.531, p = 0.009) and VEGF (r = − 0.582, p = 0.006) in MPE.
Conclusion
Pleural effusion GSDMD can be an effective marker for differentiating the different kinds of PE, and VEGF levels can be a useful adjuvant marker in screening out MPE as a possible diagnosis, leading to the proper selection of patients who may benefit from more invasive procedures.
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Jiang MP, Wen JX, Hai L, Jiang TW, Huang JH, Chen H, Wang YF, Zheng WQ, Hu ZD, Yan L. Diagnostic accuracy of pleural fluid to serum carcinoembryonic antigen ratio and delta value for malignant pleural effusion: findings from two cohorts. Ther Adv Respir Dis 2023; 17:17534666231155745. [PMID: 36927281 PMCID: PMC10026088 DOI: 10.1177/17534666231155745] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Pleural fluid (PF) carcinoembryonic antigen (CEA) is a widely used diagnostic marker for malignant pleural effusion (MPE). Recent studies revealed that PF to serum CEA was also a promising diagnostic parameter for MPE. OBJECTIVE We aimed to investigate whether PF to serum CEA ratio and delta CEA (PF minus serum CEA) provided added value to PF CEA in diagnosing MPE. METHODS Patients with pleural effusion in a retrospective cohort (BUFF) and a prospective cohort (SIMPLE) were included. The clinical characteristics of the patients were extracted from their medical records. The diagnostic value of CEA ratio and delta CEA was estimated by a receiver operating characteristics (ROC) curve, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). RESULTS A total of 148 patients in the BUFF cohort and 164 patients in the SIMPLE cohort were enrolled. The BUFF cohort had 46 MPE patients and 102 benign pleural effusion (BPE) patients, and the SIMPLE cohort had 85 MPE patients and 79 BPE patients. In both cohorts, MPE patients had significantly higher PF CEA, serum CEA, CEA ratio, and delta CEA. The area under ROC curves (AUCs) of PF CEA, CEA ratio, and delta CEA were 0.78 (95% CI: 0.67-0.88), 0.80 (95% CI: 0.72-0.89) and 0.83 (95% CI: 0.75-0.91) in the BUFF cohort, and 0.89 (95% CI: 0.83-0.94), 0.86 (95% CI: 0.80-0.92), and 0.84 (95% CI: 0.78-0.91) in the SIMPLE cohort. The differences between the AUCs of PF CEA, CEA ratio, and delta CEA did not reach statistical significance. The continuous NRI and IDI of CEA ratio and delta CEA were <0. CONCLUSION CEA ratio and delta value cannot provide added diagnostic value to PF CEA. The simultaneous determination of serum and PF CEA should not be adopted in clinical practice.
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Affiliation(s)
- Meng-Ping Jiang
- The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Jian-Xun Wen
- Department of Medical Experiment Center, The College of Basic Medicine, Inner Mongolia Medical University, Hohhot, China
| | - Ling Hai
- Department of Pathology, The College of Basic Medical, Inner Mongolia Medical University, Hohhot, China
- Department of Pathology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Ting-Wang Jiang
- Department of Key Laboratory, The Affiliated Changshu Hospital of Xuzhou Medical University, Suzhou, China
| | - Jin-Hong Huang
- Department of Pulmonary and Critical Care Medicine, The Affiliated Changshu Hospital of Xuzhou Medical University, Suzhou, China
| | - Hong Chen
- Department of Pulmonary and Critical Care Medicine, The Affiliated Changshu Hospital of Xuzhou Medical University, Suzhou, China
| | - Ya-Fei Wang
- Department of Laboratory Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Wen-Qi Zheng
- Department of Laboratory Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Zhi-De Hu
- Department of Laboratory Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010010, China
| | - Li Yan
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010010, China
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El-Sokkary RT, Abuelkassem NM, Seddik MI, Metwally A. New biomarkers for the diagnosis of pleural effusion. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2022. [DOI: 10.1186/s43168-022-00137-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Persistent undiagnosed effusion is present in approximately 15% of all causes of exudative effusion. Pleural effusion caused by immunoglobulin G4 (IgG4) is a new type of pleural effusion. Tumor markers such as Carcinoembryonic antigen (CEA) may play a role in the diagnosis of malignant pleural effusion. This study aimed to evaluate the use of serum Immunoglobulin G4 and carcinoembryonic antigen in diagnosing pleural effusion.
Methods
This observational descriptive cross-sectional study comprised 89 individuals with exudative pleural effusion who visited the Assiut university hospital's chest department. All patients were examined and asked about their medical history. Also, chest X-ray, MSCT chest, transthoracic ultrasonography, pleural fluid analysis and cytology, serum level of carcinoembryonic antigen, and immunoglobulin G4 were performed. In addition, pleural biopsy, bronchoscopy, and thoracoscopy were performed when required.
Results
In comparison to another diagnosis, the level of serum IgG 4 was observed to be substantially greater in individuals with IgG4-associated effusion (725± 225.45). Patients with malignant mesothelioma (70± 16.24) and metastatic adenocarcinoma (93.52± 19.34) had lower levels of IgG4. In contrast, the serum level of CEA was significantly higher in individuals with malignant mesothelioma (79.50± 29.47) and metastatic adenocarcinoma (68.71± 28.98). Patients with para-pneumonic effusion had a minor serum level of CEA (0.36 ± 0.26). At cutoff point > 152 mg/dl serum IgG-4 had 100% sensitivity and 94% specificity in the diagnosis of IgG4 related pleural effusion with an overall accuracy of 95.3% and area under the curve of 0.97. At the cutoff point > 5 ng/ml serum CEA had 77% sensitivity and 100% specificity in diagnosing malignant pleural effusion with an overall accuracy of 91.1% and area under the curve of 0.88.
Conclusion
Serum IgG4 higher than 152 mg/dl has good diagnostic accuracy in cases of undiagnosed pleural effusion. Carcinoembryonic antigen aids in diagnosing malignant pleural effusion with a cutoff point higher than 5 ng/ml in serum.
Trial registration
ClinicalTrials.gov registration ID NCT03260088
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Zheng WQ, Hu ZD. Pleural fluid biochemical analysis: the past, present and future. Clin Chem Lab Med 2022; 61:921-934. [PMID: 36383033 DOI: 10.1515/cclm-2022-0844] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/07/2022] [Indexed: 11/18/2022]
Abstract
Abstract
Identifying the cause of pleural effusion is challenging for pulmonologists. Imaging, biopsy, microbiology and biochemical analyses are routinely used for diagnosing pleural effusion. Among these diagnostic tools, biochemical analyses are promising because they have the advantages of low cost, minimal invasiveness, observer independence and short turn-around time. Here, we reviewed the past, present and future of pleural fluid biochemical analysis. We reviewed the history of Light’s criteria and its modifications and the current status of biomarkers for heart failure, malignant pleural effusion, tuberculosis pleural effusion and parapneumonic pleural effusion. In addition, we anticipate the future of pleural fluid biochemical analysis, including the utility of machine learning, molecular diagnosis and high-throughput technologies. Clinical Chemistry and Laboratory Medicine (CCLM) should address the topic of pleural fluid biochemical analysis in the future to promote specific knowledge in the laboratory professional community.
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Affiliation(s)
- Wen-Qi Zheng
- Department of Laboratory Medicine , The Affiliated Hospital of Inner Mongolia Medical University , Hohhot , P.R. China
| | - Zhi-De Hu
- Department of Laboratory Medicine , The Affiliated Hospital of Inner Mongolia Medical University , Hohhot , P.R. China
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5
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Exploring the value of pleural fluid biomarkers for complementary pleural effusion disease examination. Comput Biol Chem 2021; 94:107559. [PMID: 34412001 DOI: 10.1016/j.compbiolchem.2021.107559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 07/08/2021] [Accepted: 08/09/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Pleural fluid biomarkers are beneficial for the complementary diagnosis of pleural effusion etiologies. This study focuses on the multidimensional evaluation of deep learning to investigate the pleural effusion biomarkers value and the diagnostic utility of combining these markers, in distinguishing pleural effusion etiologies. METHODS Pleural effusion were divided into three groups according to the diagnosis and treatment guidelines: malignant pleural effusion (MPE), parapneumonic effusion (PPE), and congestive heart failure (CHF). First, the value of the biomarker was analyzed by a receiver operating characteristic (ROC) curve. Then by utilizing deep learning and entropy weight method (EWM), the clinical value of biomarkers was computed multidimensionally for complementary diagnosis of pleural effusion diseases. RESULTS There were significant differences in the six biomarkers, TP, ADA, CEA, CYFRA211, NSE, MNC% (p < 0.05) and no significant differences in three physical characteristics including color, transparency, specific gravity and six other biomarkers such as WBC, PNC%, MTC%, pH level, GLU, LDH (p > 0.05) among the three pleural effusion groups. The comprehensive test of pleural fluid biomarkers based on deep learning is of high accuracy. The clinical value of cytomorphology biomarkers WBC, MNC %, PNC %, MTC % was higher among pleural fluid biomarkers. CONCLUSION The clinical value of multi-dimensional analysis of biomarkers by deep learning and entropy weight method is different from the ROC curve analysis. It is suggested that during the clinical examination process, more attention should be paid to the cell morphology biomarkers, but the physical properties of the pleural fluid are less clinical significance.
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6
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Rahemi Z, Javadi A, Kazeminejad B, Ebrahimi A, Vosough H, Taghavi A, Dabiri S. Diagnostic Utility of Combined CEA, CA15-3 and CA125 Biomarkers and Cytomorphology in Suspicious and Malignant Serosal Fluid. IRANIAN JOURNAL OF PATHOLOGY 2021; 16:248-255. [PMID: 34306120 PMCID: PMC8298050 DOI: 10.30699/ijp.2021.130458.2450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 11/05/2020] [Indexed: 11/23/2022]
Abstract
Background & Objective: Early detection of malignancies in the serous fluids has been remained an issue. A classic diagnostic tool for the ascites and pleural effusions is cytologic study (morphology) with approximately 98% specificity for the detection of cancer cells. This study aimed to evaluate the diagnostic value of three complementary markers in the serosal fluids of patients with malignant cytology and suspected cases. Methods: Seventy two patients with serosal effusion treated in three teaching hospitals were studied. The cases underwent a diagnostic workup to determine the pleural effusion malignancy and etiologies. Complementary markers, including CEA, CA15-3, and CA125 were measured in serosal fluids of three categories of benign, suspicious, and malignant. The study was carried out by Chemiluminescence immunoalayzer. The morphologies were re-evaluated by a consulting Cytopathologist. Results: Of 72 serosal fluid specimens, 41 (56.9%) were related to pleural effusion and 31 (43.1%) were related to ascites. The sensitivity of CEA, CA125, and CA15-3 biomarkers were 64, 84, and 68%, respectively, and the specificity of each test was 100, 86, and 96%, respectively. This was statistically achieved for the combination of the area of markers below the curve (AUC), 0.93 and 90% sensitivity and 91% specificity. Conclusion: The results suggest that complementary CA125, CA15-3, and CEA markers assayed with well-developed immunoassay method might be useful in the differentiation between malignant and benign effusions while combined with conventional cytology. CA125 yielded a significant correlation between cytomorphology and biomarkers based on the correlation coefficient analysis.
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Affiliation(s)
- Zahra Rahemi
- Department of Pathology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abdolreza Javadi
- Department of Pathology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Imam Hossein Central Medical Laboratory, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behrang Kazeminejad
- Department of Pathology, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abdolali Ebrahimi
- Department of Pathology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Houman Vosough
- Imam Hossein Central Medical Laboratory, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Afsoon Taghavi
- Department of Pathology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahriar Dabiri
- Department of Pathology, Afzalipour Medical School, Kerman, Iran
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7
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Relations between serum and pleural fluid biomarkers: a new look of an old concept. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2020. [DOI: 10.1186/s43168-020-00004-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Although cytological examination of pleural fluid samples can simply diagnose malignant pleural effusion (MPE), this test has many limitations. There are no established biomarkers for accurate diagnosis of MPE. This study investigated the association of serum lactate dehydrogenase (LDH)/pleural fluid adenosine deaminase (ADA) which is the cancer ratio with MPE together with assessment of the utility of combining pleural lymphocyte counts “cancer ratio plus” in diagnosing MPE and to evaluate the ability of these markers in differentiating MPE from tuberculous pleural effusion (TPE).
Results
This prospective study included 150 individuals who were divided into 3 groups including malignant (n = 94), tuberculous (n = 31), and parapneumonic (n = 25) effusions. It was done during the period from January 2018 to July 2019 to assess the utility of cancer ratio and cancer ratio plus in discrimination between MPE and non-MPE. Serum LDH, cancer ratio, and cancer ratio plus were significantly associated with MPE. Also, age, cancer ratio, and serum LDH to pleural fluid lymphocyte count ratio were positive predictors of MPE. A cutoff level of > 16.02 for the cancer ratio showed sensitivity and specificity of 61% (95% CI 0.5002–0.7056) and 96% (95% CI 0.8769–0.9956) respectively. At this cutoff, the positive likelihood ratio was 16.99, while the negative likelihood ratio was 0.41.
Conclusion
Cancer ratio was found to be more accurate than cancer ratio plus and serum LDH to pleural fluid lymphocyte count ratio in identifying MPE especially in patients with negative pleural fluid cytology.
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Elia S, D’Angelo G, Palmieri F, Sorge R, Massoud R, Cortese C, Hardavella G, De Stefano A. A machine learning evolutionary algorithm-based formula to assess tumor markers and predict lung cancer in cytologically negative pleural effusions. Soft comput 2020. [DOI: 10.1007/s00500-019-04344-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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9
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Chen Z, Wang Y, Fang M. Analysis of tumor markers in pleural effusion and serum to verify the correlations between serum tumor markers and tumor size, TNM stage of lung adenocarcinoma. Cancer Med 2020; 9:1392-1399. [PMID: 31881123 PMCID: PMC7013070 DOI: 10.1002/cam4.2809] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 12/09/2019] [Accepted: 12/13/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The study of tumor markers (TM) in pleural effusion (PE) was not extensive. METHODS TM in PE and serum were analyzed to determine whether TM was expressed in intrathoracic and extrathoracic tissues. To further verify the correlations between serum TM and tumor size, TNM stage of lung adenocarcinoma. RESULTS Serum AFP was not correlated with tumor size, T stage, N stage, and M stage (P > .05). Serum CEA, serum CA125, serum CA15-3 were positively correlated with tumor size, T stage, N stage, M stage (P < .05). Serum CA19-9 was not significantly correlated with tumor size and T stage (P > .05), but was positively correlated with N stage and M stage (P < .05). The levels of PE CEA, PE CA125, PE CA15-3 were higher than those of serum CEA, serum CA125, serum CA15-3 (all P < .05). The level of PE AFP was lower than that of serum AFP (P < .05). The level of PE CA19-9 was not significantly different from that of serum CA19-9 (P > .05). The positive rates of PE CEA and PE CA125 were higher than those of serum CEA and serum CA125 (P < .05). The positive rates of PE AFP, PE CA15-3, PE CA19-9 were not significantly different from those of serum AFP, serum CA15-3, serum CA19-9 (P > .05).PE CEA, PE CA125, PE CA15-3 were moderately positively correlated with serum CEA, serum CA125, serum CA15-3, respectively (r = 0.597; r = 0.46; r = 0.583, all P < .05). However, PE AFP and PE CA19-9 were very strongly positively correlated with serum AFP and serum CA19-9, respectively (r = 0.888; r = 0.874, all P < .05). CONCLUSION The expression characteristics of TM in PE and serum supported the correlations between serum TM and tumor size, TNM stage of lung adenocarcinoma.
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Affiliation(s)
- Zhongqing Chen
- Department of Clinical LaboratoryGuangxi Medical University Cancer HospitalNanningGuangxiPeople’s Republic of China
| | - Ying Wang
- Department of Clinical LaboratoryGuangxi Medical University Cancer HospitalNanningGuangxiPeople’s Republic of China
| | - Min Fang
- Department of Clinical LaboratoryGuangxi Medical University Cancer HospitalNanningGuangxiPeople’s Republic of China
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10
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Hackner K, Errhalt P, Handzhiev S. Ratio of carcinoembryonic antigen in pleural fluid and serum for the diagnosis of malignant pleural effusion. Ther Adv Med Oncol 2019; 11:1758835919850341. [PMID: 31205509 PMCID: PMC6535745 DOI: 10.1177/1758835919850341] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 04/05/2019] [Indexed: 11/15/2022] Open
Abstract
Background Tumour markers in pleural fluid and their diagnostic value are subject to debate. Although there are several studies on this topic, standardized cut-off values do not exist. In this study we investigated the potential of a ratio of carcinoembryonic antigen (CEA) in pleural fluid and serum, serving as an individual marker for pleural cancer manifestation. Methods A total of 201 consecutive patients with unclear pleural effusion were included in the study; 98 were diagnosed with malignant pleural effusion and 103 had an effusion due to other, benign reasons. CEA levels in pleural fluid and serum were measured. Results By using receiver operating characteristics analysis, at the cut-off of 1.0, the CEA ratio showed a specificity of 92% and sensitivity of 85%, with a positive predictive value of 91% and a negative predictive value of 87%. These results are higher than in previous investigations on different pleural tumour markers and their combination. Conclusions The CEA ratio is a useful tool in predicting pleural carcinosis. Elevated results in cytology-negative patients should lead to further investigations, such as repeated cytological examination or thoracoscopy.
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Affiliation(s)
| | - Peter Errhalt
- Department of Pneumology, University Hospital Krems, Austria, and Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Sabin Handzhiev
- Department of Pneumology, University Hospital Krems, Austria, and Karl Landsteiner University of Health Sciences, Krems, Austria
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11
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Volarić D, Flego V, Žauhar G, Bulat-Kardum L. Diagnostic value of tumour markers in pleural effusions. Biochem Med (Zagreb) 2018; 28:010706. [PMID: 29472801 PMCID: PMC5806614 DOI: 10.11613/bm.2018.010706] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 11/05/2017] [Indexed: 11/11/2022] Open
Abstract
Introduction We investigated whether tumour markers carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), cancer antigen 125 (CA-125), and cytokeratin 19 fragment (CYFRA 21-1) in pleural effusions and serum can be used to distinguish pleural effusion aetiology. Materials and methods During the first thoracentesis, we measured pleural fluid and serum tumour marker concentrations and calculated the pleural fluid/serum ratio for patients diagnosed with pleural effusion, using electrochemiluminescence immunoassays. Receiver operating characteristic (ROC) analysis was carried out and the Hanley and McNeil method was used to test the significance of the difference between the areas under ROC curves (AUCs). In order to detect which tumour marker best discriminates between malignant and non-malignant pleural effusions and to establish the predictive value of those markers, discriminant function analysis (DFA) and logistic regression analysis were utilized. Results Serum tumour markers CYFRA 21-1 and NSE as well as pleural NSE were good predictors of pleural effusion malignancy and their combined model was found statistically significant (Chi-square = 28.415, P < 0.001). Respective ROC analysis showed significant discrimination value of the combination of these three markers (AUC = 0.79). Conclusions Serum markers showed superiority to pleural fluid markers in determining pleural fluid aetiology. Serum CYFRA 21-1 and NSE concentrations as well as pleural fluid NSE values had the highest clinical value in differentiating between malignant and non-malignant pleural effusions. The combination of these three markers produced a significant model to resolve pleural effusion aetiology.
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Affiliation(s)
- Darian Volarić
- Division of Pulmonology, Clinic of Internal Medicine, Clinical Hospital Centre Rijeka, Rijeka, Croatia.,Department of Internal Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Veljko Flego
- Division of Pulmonology, Clinic of Internal Medicine, Clinical Hospital Centre Rijeka, Rijeka, Croatia.,Department of Internal Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Gordana Žauhar
- Department of Medical Physics and Biophysics, Faculty of Medicine, University of Rijeka, Rijeka, Croatia.,Department of Physics, University of Rijeka, Rijeka, Croatia
| | - Ljiljana Bulat-Kardum
- Division of Pulmonology, Clinic of Internal Medicine, Clinical Hospital Centre Rijeka, Rijeka, Croatia.,Department of Internal Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
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12
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Zhai K, Wang W, Wang Y, Liu JY, Zhou Q, Shi HZ. Diagnostic accuracy of tumor markers for malignant pleural effusion: a derivation and validation study. J Thorac Dis 2017; 9:5220-5229. [PMID: 29312729 DOI: 10.21037/jtd.2017.11.62] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The utility of tumor markers (TMs) for differentiating malignant pleural effusion (MPE) from benign pleural effusion (BPE) has been a subject of controversy. The majority of published studies are single center designed and lack validation. We performed a derivation and validation study in China to evaluate the diagnostic value of carcinoembryonic antigen (CEA) as well as carbohydrate antigen (CA) 15-3, CA 19-9 and CA 125 to differentiate between MPE and BPE. Methods Three hundred and twenty seven pleural effusion (PE) and paired serum samples were collected from consecutive patients with MPE or BPE in Beijing (174 patients, derivation) and Wuhan (153 patients, validation) during the same period. The concentrations of four TMs were tested using chemiluminescent microparticle immunoassay technology. The performance of the TMs was analyzed by standard receiver operating characteristic (ROC) curves. Results The levels of four TMs were significantly higher in MPE than in BPE and the corresponding serum. The concentrations of CEA and CA 15-3 were more stable than the concentrations of CA 125 and CA 19-9. CEA was the best single marker for discriminating MPE from BPE. With a specificity of 100% in the total population, the highest sensitivity (37.8%) using serum was found in CEA. In addition, CEA presented 19.8% sensitivity in PE and 18.0% sensitivity in the Δ(PE-serum). For CA 15-3, the sensitivity was 32.4% in PE, 15.3% in the PE/serum ratio and 25.2% in the Δ(PE-serum). Conclusions CEA and CA 15-3 rather than CA 125 and CA 19-9 are more reliable to differentiate between MPE and BPE. The use of the Δ(PE-serum) value in TMs, such as CEA and CA 15-3, may improve the sensitivity and specificity of the diagnosis etiology of PE.
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Affiliation(s)
- Kan Zhai
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China.,Medical Research Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Wen Wang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Yao Wang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Jing-Yuan Liu
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Qiong Zhou
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Huan-Zhong Shi
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
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13
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Zhu J, Feng M, Liang L, Zeng N, Wan C, Yang T, Shen Y, Wen F. Is neuron-specific enolase useful for diagnosing malignant pleural effusions? evidence from a validation study and meta-analysis. BMC Cancer 2017; 17:590. [PMID: 28854885 PMCID: PMC5575856 DOI: 10.1186/s12885-017-3572-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 08/21/2017] [Indexed: 02/05/2023] Open
Abstract
Background Neuron-Specific enolase (NSE) has been used as a typical tumor marker and shows a potential to diagnose malignant pleural effusion (MPE). The ability of NSE in diagnosing MPE has been investigated in many studies, but with inconsistent conclusions. This study sought to investigate the diagnostic accuracy of NSE for MPE through a clinical study and together with a meta-analysis. Methods Pleural effusion samples from 136 patients with MPE and 102 patients with benign pleural effusion (BPE) were collected, and NSE levels were measured by electrochemiluminescence immunoassay. Receiver operating characteristic (ROC) curve analysis was performed to assess the ability of NSE to differentiate MPE from BPE. Literature search was conducted to identify suitable publications, data were extracted and diagnostic indexes including sensitivity, specificity, positive/negative likelihood ratio (PLR/NLR), and diagnostic odds ratio (DOR) were pooled. Summary ROC curve was generated to determine the overall diagnostic accuracy of NSE for MPE. Results Levels of NSE were significantly increased in pleural effusion from patients with MPE than that from BPE (18.53 ± 27.30 vs. 6.41 ± 6.95 ng/ml, p < 0.001). With a cut-off value of 8.92 ng/ml, pleural NSE had a sensitivity of 59.56% and a specificity of 83.33% in diagnosing MPE. A total of 14 studies with 1896 subjects were included for meta-analysis. The diagnostic parameters of NSE were listed as follows: sensitivity, 0.53 (95% CI: 0.38–0.67); specificity, 0.85 (95% CI: 0.75–0.91); PLR, 3.54 (95% CI: 2.33–5.39); NLR, 0.56 (95% CI: 0.42–0.73); and DOR, 6.39 (95% CI: 3.72–10.96). The area under the summary ROC curve was 0.78. Conclusions The role of pleural NSE measurement in diagnosing MPE is limited and with a low sensitivity. The clinical utility of NSE assay should be combined with the results of other tumor markers examination and the detail clinical information of patient. Further studies are needed to confirm the role of NSE in diagnosing MPE. Electronic supplementary material The online version of this article (10.1186/s12885-017-3572-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jing Zhu
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, 610041, China
| | - Mei Feng
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, 610041, China
| | - Liqun Liang
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, 610041, China
| | - Ni Zeng
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, 610041, China
| | - Chun Wan
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, 610041, China
| | - Ting Yang
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, 610041, China
| | - Yongchun Shen
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, 610041, China.
| | - Fuqiang Wen
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, 610041, China
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14
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Trapé J, Sant F, Franquesa J, Montesinos J, Arnau A, Sala M, Bernadich O, Martín E, Perich D, Pérez C, Lopez J, Ros S, Esteve E, Pérez R, Aligué J, Gurt G, Catot S, Domenech M, Bosch J, Badal JM, Bonet M, Molina R, Ordeig J. Evaluation of two strategies for the interpretation of tumour markers in pleural effusions. Respir Res 2017; 18:103. [PMID: 28545517 PMCID: PMC5445332 DOI: 10.1186/s12931-017-0582-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 05/11/2017] [Indexed: 11/30/2022] Open
Abstract
Background Pleural effusions present a diagnostic challenge. Approximately 20% are associated with cancer and some 50% require invasive procedures to perform diagnosis. Determination of tumour markers may help to identify patients with malignant effusions. Two strategies are used to obtain high specificity in the differential diagnosis of malignant pleural effusions: a) high cut-off, and b) fluid/serum (F/S) ratio and low cut-off. The aim of this study is to compare these two strategies and to establish whether the identification of possible false positives using benign biomarkers – ADA, CRP and % of polymorphonuclear cells – improves diagnostic accuracy. Methods We studied 402 pleural effusions, 122 of them malignant. Benign biomarkers were determined in pleural fluid, and CEA, CA72-4, CA19-9 and CA15-3 in pleural fluid and serum. Results Establishing a cut-off value for each TM for a specificity of 100%, a joint sensitivity of 66.5% was obtained. With the F/S strategy and low cut-off points, sensitivity was 77% and specificity 98.2%, Subclassifying cases with negative benign biomarkers, both strategies achieved a specificity of 100%; sensitivity was 69.9% for single determination and 80.6% for F/S ratio. Conclusions The best interpretation of TM in the differential diagnosis of malignant pleural effusions is obtained using the F/S ratio in the group with negative benign biomarkers.
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Affiliation(s)
- Jaume Trapé
- Department of Laboratory Medicine, Althaia Xarxa Assistencial Universitària de Manresa, Dr Joan Soler 1-3, 08243, Manresa, Catalonia, Spain.
| | - Francesc Sant
- Department of Pathology, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Catalonia, Spain
| | - Josefina Franquesa
- Department of Laboratory Medicine, Althaia Xarxa Assistencial Universitària de Manresa, Dr Joan Soler 1-3, 08243, Manresa, Catalonia, Spain
| | - Jesús Montesinos
- Department of Oncology, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Catalonia, Spain
| | - Anna Arnau
- Clinical Research Unit, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Catalonia, Spain
| | - Maria Sala
- Department of Laboratory Medicine, Althaia Xarxa Assistencial Universitària de Manresa, Dr Joan Soler 1-3, 08243, Manresa, Catalonia, Spain
| | - Oscar Bernadich
- Department of Pulmonary Diseases, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Catalonia, Spain
| | - Esperanza Martín
- Department of Pulmonary Diseases, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Catalonia, Spain
| | - Damià Perich
- Department of Pulmonary Diseases, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Catalonia, Spain
| | - Concha Pérez
- Department of Pulmonary Diseases, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Catalonia, Spain
| | - Joan Lopez
- Department of Laboratory Medicine, Althaia Xarxa Assistencial Universitària de Manresa, Dr Joan Soler 1-3, 08243, Manresa, Catalonia, Spain
| | - Sandra Ros
- Department of Pulmonary Diseases, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Catalonia, Spain
| | - Enrique Esteve
- Department Internal Medicine, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Catalonia, Spain
| | - Rafael Pérez
- Department Internal Medicine, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Catalonia, Spain
| | - Jordi Aligué
- Department Internal Medicine, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Catalonia, Spain
| | - Gabriel Gurt
- Polytechnic School of University of Vic, Universitat Central de Catalunya, Vic, Catalonia, Spain
| | - Silvia Catot
- Department of Oncology, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Catalonia, Spain
| | - Montserrat Domenech
- Department of Oncology, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Catalonia, Spain
| | - Joan Bosch
- Department of Medicine, Universitat Internacional de Catalunya, Sant Cugat, Catalonia, Spain
| | - Josep Miquel Badal
- Department of Pathology, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Catalonia, Spain
| | - Mariona Bonet
- Department Internal Medicine, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Catalonia, Spain
| | - Rafael Molina
- Laboratory of Biochemistry (Oncobiology Unit), Biomedical Diagnostic Center (CDB), Hospital Clinic, IDIBAPS, University of Barcelona, Catalonia, Spain
| | - Josep Ordeig
- Department Internal Medicine, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Catalonia, Spain
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15
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Gu Y, Zhai K, Shi HZ. Clinical Value of Tumor Markers for Determining Cause of Pleural Effusion. Chin Med J (Engl) 2017; 129:253-8. [PMID: 26831224 PMCID: PMC4799566 DOI: 10.4103/0366-6999.174501] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: It is often challenging to distinguish tuberculous pleural effusion (TPE) from malignant pleural effusion (MPE); thoracoscopy is among the techniques with the highest diagnostic ability in this regard. However, such invasive examinations cannot be performed on the elderly, or on those in poor physical condition. The aim of this study was to explore the differential diagnostic value of carbohydrate antigen 125 (CA125), carbohydrate antigen 199 (CA199), carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), and squamous cell carcinoma (SCC) associated antigen in patients with TPE and MPE. Methods: Using electrochemiluminescence, we measured the concentration of tumor markers (TMs) in the pleural effusion and serum of patients with TPE (n = 35) and MPE (n = 95). We used receiver operating characteristic (ROC) curve analysis to evaluate the TMs and differentiate between TPE and MPE. Results: The cut-off values for each TM in serum were: CA125, 151.55 U/ml; CA199, 9.88 U/ml; CEA, 3.50 ng/ml; NSE, 13.27 ng/ml; and SCC, 0.85 ng/ml. Those in pleural fluid were: CA125, 644.30 U/ml; CA199, 12.08 U/ml; CEA, 3.35 ng/ml; NSE, 9.71 ng/ml; and SCC, 1.35 ng/ml. The cut-off values for the ratio of pleural fluid concentration to serum concentration (P/S ratio) of each TM were: CA125, 5.93; CA199, 0.80; CEA, 1.47; NSE, 0.76; and SCC, 0.90. The P/S ratio showed the highest specificity in the case of CEA (97.14%). ROC curve analysis revealed that, for all TMs, the area under the curve in pleural fluid (0.95) was significantly different from that in serum (0.85; P < 0.001). Conclusions: TMs in TPE differ significantly from those in MPE, especially when detected in pleural fluid. The combined detection of TMs can improve diagnostic sensitivity.
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Affiliation(s)
| | | | - Huan-Zhong Shi
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing 100020; Center of Medical Research, Beijing Institute of Respiratory Diseases, Beijing 100020, China
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16
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Darooei R, Sanadgol G, Gh-Nataj A, Almasnia M, Darivishi A, Eslaminejad A, Raoufy MR. Discriminating Tuberculous Pleural Effusion from Malignant Pleural Effusion Based on Routine Pleural Fluid Biomarkers, Using Mathematical Methods. TANAFFOS 2017; 16:157-165. [PMID: 29308081 PMCID: PMC5749329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The differential diagnosis of tuberculous pleural effusion (TPE) and malignant pleural effusion (MPE) is difficult because the biochemical profiles are similar. The present study aimed to differentiate TPE from MPE, using a decision tree and a weighted sparse representation-based classification (WSRC) method, based on the best combination of routine pleural effusion fluid biomarkers. MATERIALS AND METHODS The routine biomarkers of pleural fluid, including differential cell count, lactate dehydrogenase (LDH), protein, glucose and adenosine deaminase (ADA), were measured in 236 patients (100 with TPE and 136 with MPE). A Sequential Forward Selection (SFS) algorithm was employed to obtain the best combination of parameters for the classification of pleural effusions. Moreover, WSRC was compared to the standard sparse representation-based classification (SRC) and the Support Vector Machine (SVM) methods for classification accuracy. RESULTS ADA provided the highest diagnostic performance in differentiating TPE from MPE, with 91.91% sensitivity and 74.0% specificity. The best combination of parameters for discriminating TPE from MPE included age, ADA, polynuclear leukocytes and lymphocytes. WSRC outperformed the SRC and SVM methods, with an area under the curve of 0.877, sensitivity of 93.38%, and specificity of 82.0%. The generated flowchart of the decision tree demonstrated 87.2% accuracy for discriminating TPE from MPE. CONCLUSION This study indicates that a decision tree and a WSRC are novel, noninvasive, and inexpensive methods, which can be useful in discriminating between TPE and MPE, based on the combination of routine pleural fluid biomarkers.
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Affiliation(s)
- Reza Darooei
- School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ghazal Sanadgol
- Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arman Gh-Nataj
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mehdi Almasnia
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Asma Darivishi
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Eslaminejad
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Raoufy
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran,,Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran,,Correspondence to: Raoufy MR, Address: Tarbiat Modares University, Nasr Bridge, Jalal Al Ahmad Highway, Tehran, Iran, Email address:
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17
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Evaluation of predictive value of pleural CEA in patients with pleural effusions and histological findings: A prospective study and literature review. Clin Biochem 2016; 49:1227-1231. [PMID: 27521620 DOI: 10.1016/j.clinbiochem.2016.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/04/2016] [Accepted: 08/05/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Pleural effusion recognizes heterogeneous etiology and pathogenesis and requires invasive diagnostic procedures. Usually, after pleural fluid analysis, 30-50% of patients with malignant pleural effusion exhibit negative pleural cytology, and the sensitivity of image-guided pleural needle-aspiration biopsy ranges between 60% and 70%. With the aim of differentiating between benign (BPE) and malignant (MPE) pleural effusions, several tumor markers have been assayed in the pleural fluid and the majority of studies focus on pleural carcinoembryonic antigen (p-CEA). The aims of this study were to evaluate (i) the diagnostic accuracy of p-CEA of patients with pleural effusions undergoing video-assisted thoracoscopic surgery (VATS) for diagnostic purpose, (ii) the relationship between p-CEA and serum CEA (s-CEA), and (iii) the usefulness of the p-CEA/s-CEA ratio in the diagnosis of malignant pleural effusions (MPE). DESIGN & METHODS We prospectively enrolled in the study 134 consecutive patients with pleural effusions, scheduled for having VATS and biopsy. The final diagnosis, based on histopathology of the VATS-guided specimens, was available for all patients. p-CEA and s-CEA was assayed with a chemiluminescence immunoassay method (CLIA), applied on the Maglumi 2000 Plus automated platform (SNIBE, Shenzen, China). RESULTS The sensitivity and accuracy of p-CEA was significantly higher than that of pleural cytology at the same specificity comparing BPE with MPE and BPE with non-small lung cancer. The sensitivity of p-CEA and PC together reached 100% (BPE vs. NSCLC) and 91.5% (BPE vs. MPE excluding mesothelioma), respectively. CONCLUSIONS The p-CEA measurement in patients with pleural effusion of uncertain etiology is a safe and cost-effective procedure, everywhere easily available, which may help clinicians in selecting patients for further evaluations. An elevated p-CEA level in a patient with pleural effusion and negative pleural cytology suggests the need of more invasive procedure (e.g. VATS-guided biopsies), whilst low p-CEA may support a follow-up.
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18
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Evaluation of pleural fluid YKL-40 as a marker of malignant pleural effusion. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2015.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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19
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El-Shimy WS, El-Shafey BI, El-Sorougy HA, El-Monem EAA. Diagnostic value of cyfra 21-1 and carcinoembryonic antigen in differentiation between benign and malignant pleural effusion. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2015.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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20
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Liu H, Li C, Wang H, Huang Z, Zhang P, Pan Z, Wang L. Characterization of Volatile Organic Metabolites in Lung Cancer Pleural Effusions by SPME–GC/MS Combined with an Untargeted Metabolomic Method. Chromatographia 2014. [DOI: 10.1007/s10337-014-2720-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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21
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Xu CH, Hao KK, Yu LK, Zhang XW. Diagnostic value of soluble receptor-binding cancer antigen expressed on SiSo cells and carcinoembryonic antigen in malignant pleural effusion in patients with lung cancer. Asia Pac J Clin Oncol 2014; 11:28-33. [PMID: 24720371 DOI: 10.1111/ajco.12195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Chun-hua Xu
- First Department of Respiratory Medicine; Nanjing Chest Hospital; Nanjing China
| | - Ke-ke Hao
- First Department of Respiratory Medicine; Nanjing Chest Hospital; Nanjing China
| | - Li-ke Yu
- First Department of Respiratory Medicine; Nanjing Chest Hospital; Nanjing China
| | - Xiu-wei Zhang
- Department of Respiratory Medicine; Nanjing Jiangning Hospital; Nanjing China
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22
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Block DR, Algeciras-Schimnich A. Body fluid analysis: Clinical utility and applicability of published studies to guide interpretation of today’s laboratory testing in serous fluids. Crit Rev Clin Lab Sci 2013; 50:107-24. [DOI: 10.3109/10408363.2013.844679] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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23
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Diagnostic value of pleural interleukin 17 and carcinoembryonic antigen in lung cancer patients with malignant pleural effusions. Tumour Biol 2013; 35:1599-603. [PMID: 24072496 DOI: 10.1007/s13277-013-1220-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 09/16/2013] [Indexed: 12/27/2022] Open
Abstract
Interleukin 17 (IL-17) has been found to be increased in some human cancers; however, the possible implication of IL-17 in regulating antitumor responses in lung cancer patients with malignant pleural effusions (MPE) remains to be elucidated. This study aimed to investigate the diagnostic value of pleural IL-17 and carcinoembryonic antigen (CEA) in MPE and benign pleural effusions (BPE). Pleural effusion samples from 108 patients were classified on the basis of diagnosis as MPE (n = 56) and BPE (n = 52). The concentration of IL-17 was determined by enzyme-linked immunosorbent assay (ELISA). The CEA levels were also determined in all patients. A significant difference was observed in the levels of CEA (P < 0.01) between MPE and BPE. The concentration of IL-17 in MPE was significantly higher compared to that in BPE (P < 0.01). With a cutoff point of 15.7 pg/ml, IL-17 had a sensitivity of 76.8 % and a specificity of 80.8 % for differential diagnosis. The combined detection of IL-17 and CEA had a sensitivity of 96.4 % and a specificity of 92.3 % to distinguish MPE from BPE. The combined detection of IL-17 and CEA may be more valuable in the differential diagnosis between MPE and BPE.
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24
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Filiberti R, Parodi S, Libener R, Ivaldi GP, Canessa PA, Ugolini D, Bobbio B, Marroni P. Diagnostic value of mesothelin in pleural fluids: comparison with CYFRA 21-1 and CEA. Med Oncol 2013; 30:543. [PMID: 23532816 DOI: 10.1007/s12032-013-0543-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 03/13/2013] [Indexed: 12/17/2022]
Abstract
CYFRA 21-1 and CEA have been applied for the differential diagnosis of malignant pleural mesothelioma (MPM). The soluble mesothelin-related peptide (SMRP) has been proposed as a specific marker for distinguishing MPM from benign diseases and other malignancies in pleural effusions (PEs). In this study, we evaluated the usefulness of SMRP in PEs in the detection of mesotheliomas by comparing it with that of CYFRA 21-1, CEA, and with cytological examination. One hundred and seventy-seven consecutive patients (57 MPM, 64 metastatic tumors, and 56 benign diseases) were evaluated using commercial tests. The performance of the markers was analyzed by standard ROC analysis methods, using the area under a ROC curve (AUC) as a measure of accuracy. CYFRA 21-1 better differentiated malignant from benign effusions. The corresponding area under the receiver operating characteristic curve was 0.87, while it was 0.74 for SMRP and 0.64 for CEA (p < 0.001). Conversely, SMRP differentiated MPM from all other PEs better than both CYFRA 21-1 and CEA (AUC = 0.84, 0.76, and 0.32, respectively, p = 0.003). Low levels of CEA were associated with a MPM diagnosis. The AUC for differentiating MPM from metastases was 0.81 for SMRP, 0.61 for CYFRA 21-1, and 0.20 for CEA (p < 0.001). In cases with negative or suspicious cytology, SMRP and CYFRA 21-1 identified 36/71 and 46/66 malignant PEs (29 and 31 MPM, respectively). Only 1 MPM showed a high CEA concentration. No single marker showed the best performance in any comparison. Results suggest that SMRP could improve CYFRA 21-1 and CEA accuracy in the differential diagnosis of MPM.
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MESH Headings
- Aged
- Aged, 80 and over
- Antigens, Neoplasm/biosynthesis
- Antigens, Neoplasm/chemistry
- Biomarkers, Tumor/biosynthesis
- Biomarkers, Tumor/chemistry
- Diagnosis, Differential
- Female
- GPI-Linked Proteins/biosynthesis
- GPI-Linked Proteins/chemistry
- Humans
- Keratin-19/biosynthesis
- Keratin-19/chemistry
- Lung Neoplasms/chemistry
- Lung Neoplasms/diagnosis
- Lung Neoplasms/metabolism
- Male
- Mesothelin
- Mesothelioma/chemistry
- Mesothelioma/diagnosis
- Mesothelioma/metabolism
- Mesothelioma, Malignant
- Middle Aged
- Pleural Effusion, Malignant/diagnosis
- Pleural Effusion, Malignant/metabolism
- Receptors, Cell Surface/biosynthesis
- Receptors, Cell Surface/chemistry
- Receptors, Cell Surface/metabolism
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Affiliation(s)
- Rosa Filiberti
- Epidemiology, Biostatistics and Clinical Trials, IRCCS AOU San Martino-IST, Largo R. Benzi, 10, Genoa 16132, Italy.
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Clinical significance of CYFRA21-1, Scc-Ag and telomerase activity in serum and pleural effusion of patients with squamous-cell lung cancer. Bioanalysis 2013; 4:2367-74. [PMID: 23088463 DOI: 10.4155/bio.12.203] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The aim was to evaluate the diagnostic value of CYFRA21-1, Scc-Ag and telomerase activity in serum and pleural effusion in patients with squamous-cell lung cancer. CYFRA21-1, Scc-Ag and telomerase activity were measured using electrochemiluminescent, microparticle enzyme immunoassay and telomeric-repeat amplification protocol. RESULTS We evaluated 302 patients diagnosed with squamous-cell lung cancer and 153 patients diagnosed with benign lung diseases. All examined tumor markers were higher in pleural effusion than serum (p < 0.05). The areas under receiver operating characteristic curve of CYFRA21-1 and Scc-Ag were higher in pleural effusion than serum. Optimizations for sensitivity, specificity and specificity in pleural effusion for CYFRA21-1 + Scc-Ag: 88.24, 97.17 and 92.79%; telomerase activity + Scc-Ag: 90.2, 95.28 and 92.8%; CYFRA21-1, Scc-Ag + telomerase activity: 91.18, 96.86 and 94.64%; respectively. Optimizations for sensitivity, specificity and specificity in serum for CYFRA21-1 + telomerase activity: 81.37, 94.34 and 87.98%; CYFRA21-1 + Scc-Ag and telomerase activity: 87.25, 93.08 and 90.8%; respectively. CONCLUSION The combined detection of tumor markers in pleural effusion showed higher sensitivity, better accuracy and higher clinical value than serum and single detection. However, the cost-effectiveness of these methods should be considered in clinical practice.
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Biaoxue R, Shuanying Y, Xiguang C, Wei Z, Wei L. Differential diagnostic CYFRA 21-1 level for benign and malignant pleural effusions: a meta-analysis in the Chinese population. Arch Med Sci 2012; 8. [PMID: 23185183 PMCID: PMC3506225 DOI: 10.5114/aoms.2012.30831] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Many studies have investigated the usefulness of cytokeratin 19 fragments (CYFRA 21-1) in pleural fluid for the differential diagnosis of benign (BPE) and malignant pleural (MPE) effusions. In the present meta-analysis, the reported studies on the diagnosis between CYFRA 21-1 and pleural effusion were assessed to summarize the diagnostic characteristics of CYFRA 21-1 in Chinese patients. MATERIAL AND METHODS The data sources from the creation of each database up to January 2011 included Medline, Chinese National Knowledge Infrastructure, EMBASE, Cochrane Library, and bibliographies of review and original articles. Through a systematic literature search for publications, the data from 22 studies were summarized based on their discussions on the result of the CYFRA 21-1 assay in pleural effusion and differential diagnosis evaluation in the Chinese population. RESULTS A total of 22 studies were available for analysis, and the high CYFRA 21-1 level in MPE was significantly associated with risk for lung cancer (standardized mean difference [SMD] = 1.65, 95% confidence interval [CI] = 1.48-1.82, Z = 18.97, p < 0.00001) compared with BPE. The CYFRA 21-1 level in pleural effusion (13 studies) was significantly higher than that in serum (SMD = 1.10, 95% CI = 0.71-1.48, Z = 5.59, p < 0.00001). The risk for squamous cell carcinoma (SCC) for CYFRA 21-1 was 1.03 (95% CI = 0.64-1.42, Z = 5.15, p < 0.00001) compared with that of adenocarcinoma (8 studies). The sensitivity of CYFRA 21-1 reported in the articles ranged from 46% to 94%, and the specificity ranged from 57% to 100%. The summary measure of the test characteristics derived from the summary receiver operating characteristic curve was 81% for both sensitivity and specificity (17 studies). CONCLUSIONS The measurement of pleural CYFRA 21-1 is likely to be a useful diagnostic tool for the confirmation of MPE.
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Affiliation(s)
- Rong Biaoxue
- Department of Respiratory Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yang Shuanying
- Department of Respiratory Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Cai Xiguang
- Department of Respiratory Medicine, The People's Hospital of Gansu Province, Lanzhou, Gansu, China
| | - Zhang Wei
- Department of Thoracic Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Li Wei
- Department of Respiratory Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Elsammak MY, Attia A, Hassan HA, Zaytoun TM, Shorman M, Suleman M. Evaluation of pleural fluid human epididymis 4 (HE4) as a marker of malignant pleural effusion. Tumour Biol 2012; 33:1701-7. [PMID: 22684816 DOI: 10.1007/s13277-012-0427-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 05/23/2012] [Indexed: 11/24/2022] Open
Abstract
Pleural effusion is a commonly encountered problem in clinical practice, and pleural fluid analysis is usually the first step towards identifying the underlying etiology. Numerous studies have been published analyzing the potential utility of measuring biomarkers in pleural fluid as possible indicators of a malignant effusion; however, there are no studies that have examined the presence of human epididymis 4 (HE4) in pleural effusions. The aims of this study were to assess pleural effusion and serum concentrations of HE4 in patients with different types of pleural effusions and to evaluate the diagnostic performance of HE4 in detecting malignant pleural effusion. A prospective cohort study was carried out of 88 consecutive patients presenting with pleural effusions. The patients were divided into three groups: 22 patients with transudative effusions, 32 patients with non-malignant exudative effusions, and 34 patients with malignant pleural effusions. Blood and pleural fluid HE4 levels were measured using immunoassay. Both serum HE4 levels and pleural effusion HE4 levels were significantly higher in patients with malignant effusions than in patients with transudative or non-malignant exudative effusions. A pleural fluid HE4 cutoff value of 1,675 pmol/L was found to predict malignant pleural effusions with a diagnostic sensitivity of 85.3 % and specificity of 90.7 %. The current study reports a novel finding of increased serum and pleural fluid HE4 levels in patients with malignant effusions compared to non-malignant effusions. This finding has the potential to strengthen the diagnostic performance of tumor markers in detecting malignant pleural effusions.
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Affiliation(s)
- Mohamed Y Elsammak
- Department of Chemical Pathology, King Fahad Specialist Hospital Dammam, Dammam, 31444, Saudi Arabia.
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