Paganuzzi M, Onetto M, Marroni P, Filiberti R, Tassara E, Parodi S, Felletti R
Clinical Pathology Laboratory, National Institute for Cancer Research, Genoa, Italy.
Chest. 2001 Apr;119(4):1138-42. doi: 10.1378/chest.119.4.1138.
The aim of our study was to assess the clinical value of CYFRA 21-1 tumor marker and carcinoembryonic antigen (CEA) as diagnostic tools that are complementary to cytology in the diagnosis of malignant mesotheliomas.
We measured CEA and CYFRA 21-1 in the pleural effusions (PEs) and serum of 106 patients (benign lung disease, 34 patients; bronchogenic and metastatic carcinoma, 40 patients; mesothelioma, 32 patients).
CEA and CYFRA 21--1 levels were determined by means of two commercial enzyme immunoassays.
The cutoff levels of CYFRA 21--1 and CEA in malignant PEs, selected on the basis of the best diagnostic efficacy, were 41.9 ng/mL and 5.0 ng/mL, respectively. In all neoplastic PEs, CYFRA 21--1 and CEA sensitivity was 78% and 30.6%, respectively, with a specificity of 80% and 91%, respectively. The sensitivity of CYFRA 21--1 and CEA in patients with mesothelioma was 87.5% and 3.1%, respectively. The results of the CYFRA 21--1 assay were positive in 17 of 19 cases of mesothelioma (89.5%) with a negative or uncertain cytology. The association of the tumor marker assay and the cytology allowed a correct diagnosis in 30 of 32 cases of mesothelioma (93.7%).
This study suggests that CYFRA 21--1 would provide a useful parameter for the differential diagnosis between benign and malignant PE from mesothelioma when the result of cytology is negative or uncertain and the clinical context does not allow a more aggressive approach. Moreover, the association of CYFRA 21--1 with CEA could provide details for a differential diagnosis between mesotheliomas and carcinomas. In fact, an elevated CYFRA 21--1 level with a low CEA level is highly suggestive of mesothelioma, whereas high levels of CEA alone or high levels of both the markers suggest a diagnosis of malignant PE, excluding mesothelioma.
我们研究的目的是评估细胞角蛋白片段21-1（CYFRA 21-1）肿瘤标志物和癌胚抗原（CEA）作为诊断工具在恶性间皮瘤诊断中对细胞学检查的补充临床价值。
我们检测了106例患者胸腔积液（PE）和血清中的CEA及CYFRA 21-1水平（良性肺部疾病患者34例；支气管源性癌和转移性癌患者40例；间皮瘤患者32例）。
采用两种商用酶免疫测定法测定CEA和CYFRA 21-1水平。
根据最佳诊断效能选择的恶性胸腔积液中CYFRA 21-1和CEA的临界值分别为41.9 ng/mL和5.0 ng/mL。在所有肿瘤性胸腔积液中，CYFRA 21-1和CEA的敏感性分别为78%和30.6%，特异性分别为80%和91%。CYFRA 21-1和CEA在间皮瘤患者中的敏感性分别为87.5%和3.1%。CYFRA 21-1检测结果在19例细胞学检查为阴性或不确定的间皮瘤病例中有17例呈阳性（89.5%）。肿瘤标志物检测与细胞学检查相结合，在32例间皮瘤病例中有30例（93.7%）得以正确诊断。
本研究表明，当细胞学检查结果为阴性或不确定且临床情况不允许采取更积极的方法时，CYFRA 21-1可为鉴别良性和恶性胸腔积液与间皮瘤提供有用参数。此外，CYFRA 21-1与CEA联合使用可为间皮瘤和癌的鉴别诊断提供详细信息。事实上，CYFRA 21-1水平升高而CEA水平较低高度提示间皮瘤，而单独CEA水平升高或两种标志物水平均升高则提示恶性胸腔积液的诊断，排除间皮瘤。
