Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA.
Clin Biochem. 2010 Sep;43(13-14):1051-5. doi: 10.1016/j.clinbiochem.2010.05.016. Epub 2010 Jun 8.
Tumor markers analysis has been proposed as a less invasive alternative for categorizing malignant and non-malignant pleural effusions. This study establishes diagnostic cutoffs for CEA and CA19-9 in pleural fluid to differentiate etiologies of effusions.
Pleural effusions obtained from 198 patients (100 malignant, 98 non-malignant) were analyzed for CEA and CA19-9. ROC curve analysis was performed to determine analyte cutoffs, and cutoff performance was examined in various subsets of malignancies.
CEA and CA19-9 concentrations were significantly higher in malignant effusions compared to non-malignant effusions, particularly in effusions caused by lung cancer and other cancers associated with elevated CEA and/or CA19-9 serum concentrations. Concentrations were not elevated in effusions caused by cancers not associated with serum tumor marker elevations.
Measurement of CEA and CA19-9 in pleural fluid complements cytology and other classifying tests. Performance is specifically enhanced in effusions caused by malignancies known to secrete CEA or CA19-9, and their use should be tailored to patients suspected of having those malignancies. Routine analysis of these markers is therefore not recommended in all pleural effusions. Moreover, negative results should be correlated with serum levels to assist in the clinical interpretation.
肿瘤标志物分析已被提议作为一种侵入性较小的方法来对恶性和非恶性胸腔积液进行分类。本研究建立了胸腔积液中 CEA 和 CA19-9 的诊断截断值，以区分胸腔积液的病因。
分析了 198 例患者（100 例恶性，98 例非恶性）的胸腔积液中的 CEA 和 CA19-9。进行 ROC 曲线分析以确定分析物的截断值，并在各种恶性肿瘤亚组中检查截断值的性能。
与非恶性胸腔积液相比，恶性胸腔积液中的 CEA 和 CA19-9 浓度明显更高，尤其是在由肺癌和其他与 CEA 和/或 CA19-9 血清浓度升高相关的癌症引起的胸腔积液中。在与血清肿瘤标志物升高无关的癌症引起的胸腔积液中，浓度没有升高。
胸腔积液中 CEA 和 CA19-9 的测量补充了细胞学和其他分类测试。在已知分泌 CEA 或 CA19-9 的恶性肿瘤引起的胸腔积液中，其性能得到了特别增强，应根据怀疑患有这些恶性肿瘤的患者来使用。因此，不建议在所有胸腔积液中常规分析这些标志物。此外，阴性结果应与血清水平相关联，以协助临床解释。
