From the Department of Pulmonary Medicine and Center of Experimental Medicine, Affiliated Hospital of Jiangsu University, 438 North Jiefang Street, Zhenjiang 212001, China.
From the Department of Pulmonary Medicine and Center of Experimental Medicine, Affiliated Hospital of Jiangsu University, 438 North Jiefang Street, Zhenjiang 212001, China
QJM. 2014 Dec;107(12):1001-7. doi: 10.1093/qjmed/hcu130. Epub 2014 Jun 16.
The sensitivity of conventional cytology for the detection of tumor cells in pleural effusion (PE) is inadequate. Mucine 1 (MUC1) and epithelial cell adhesion molecule (EpCAM) are two frequently and intensely expressed tumor-associated antigens in malignancies of epithelial origin.
To evaluate the diagnostic value of pleural fluid MUC1 and EpCAM mRNA in differentiating benign and malignant PE.
Fifty-eight patients with malignant PE and 40 patients with benign PE were included in this study. Pleural fluid MUC1 and EpCAM mRNA levels were measured by quantitative real-time PCR. Carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (Cyfra21-1) were also detected simultaneously. The receiver operating characteristic (ROC) curves were constructed to assess diagnostic performance of the four tumor markers in PE.
For the diagnosis of malignant PE, MUC1 and EpCAM mRNA had larger area under ROC curves (0.916 and 0.922) and higher sensitivity (67.2 and 70.7%) with the same specificity, when compared with CEA and Cyfra21-1 (0.821 and 0.780; 48.3 and 44.8%, respectively). By combining cytology with MUC and EpCAM, a positive result indicating the presence of malignancy was achieved in 87.9%, with a good specificity of 95%.
Compared with CEA and Cyfra21-1, the performance of MUC1 and EpCAM mRNA in malignant PE diagnosis was better. MUC1 and EpCAM mRNA in combination with cytology is a highly sensitive and specific diagnostic tool for detecting malignancy in PE.
传统细胞学检测胸腔积液（PE）中肿瘤细胞的灵敏度不足。黏蛋白 1（MUC1）和上皮细胞黏附分子（EpCAM）是两种在上皮来源恶性肿瘤中经常强烈表达的肿瘤相关抗原。
评估胸腔积液 MUC1 和 EpCAM mRNA 区分良恶性 PE 的诊断价值。
本研究纳入 58 例恶性 PE 患者和 40 例良性 PE 患者。采用实时定量 PCR 检测胸腔积液 MUC1 和 EpCAM mRNA 水平，同时检测癌胚抗原（CEA）和细胞角蛋白 19 片段（Cyfra21-1）。构建受试者工作特征（ROC）曲线评估 4 种肿瘤标志物在 PE 中的诊断性能。
在诊断恶性 PE 方面，MUC1 和 EpCAM mRNA 的 ROC 曲线下面积（0.916 和 0.922）大于 CEA 和 Cyfra21-1（0.821 和 0.780），且具有相同的特异性，其敏感性（67.2%和 70.7%）亦更高。当细胞学与 MUC 和 EpCAM 联合时，阳性结果提示恶性肿瘤的存在率为 87.9%，特异性为 95%。
与 CEA 和 Cyfra21-1 相比，MUC1 和 EpCAM mRNA 在恶性 PE 诊断中的性能更好。MUC1 和 EpCAM mRNA 联合细胞学是一种检测 PE 恶性肿瘤的高灵敏度和特异性诊断工具。
