Antonangelo L, Sales R K, Corá A P, Acencio M M P, Teixeira L R, Vargas F S
Pleura Laboratory, Pulmonary Division, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil; ; Clinical Laboratory and LIM 3, Department of Pathology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
Pleura Laboratory, Pulmonary Division, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil;
Curr Oncol. 2015 Oct;22(5):e336-41. doi: 10.3747/co.22.2563.
The presence of tumour cells in pleural fluid or tissue defines an effusion as malignant. Cytology analysis of the pleural fluid has about 60% diagnostic sensitivity. Several tests have been proposed to improve diagnosis-among them, the concentrations of tumour markers in pleural fluid. We evaluated whether the concentrations of tumour markers in pleural fluid could improve the diagnosis of malignant pleural effusion (mpe) when cytology is doubtful.
Lymphocytic pleural fluids secondary to tuberculosis or malignancy from 156 outpatients were submitted for cytology and tumour marker quantification [carcinoembryonic antigen (cea), cancer antigen 15-3 (ca15-3), carbohydrate antigen 19-9 (ca19-9), cancer antigen 72-4 (ca72-4), cancer antigen 125 (ca125), and cyfra 21-1). Oneway analysis of variance, the Student t-test or Mann-Whitney test, and receiver operating characteristic curves were used in the statistical analysis.
Concentrations of the tumour markers cea, ca15-3, ca125, and cyfra 21-1 were higher in mpes than they were in the benign effusions (p < 0.001), regardless of cytology results. The markers ca19-9 and ca72-4 did not discriminate malignant from benign effusions. When comparing the concentrations of tumour markers in mpes having positive, suspicious, or negative cytology with concentrations in benign effusions, we observed higher levels of cea, ca15-3, cyfra 21-1, and ca125 in malignant effusions with positive cytology (p = 0.003, p = 0.001, p = 0.002, and p = 0.001 respectively). In pleural fluid, only ca125 was higher in mpes with suspicious or negative cytology (p = 0.001) than in benign effusions.
Given high specificity and a sensitivity of about 60%, the concentrations of tumour markers in pleural effusions could be evaluated in cases of inconclusive cytology in patients with a high pre-test chance of malignancy or a history of cancer.
胸腔积液或组织中存在肿瘤细胞可将胸腔积液定义为恶性。胸腔积液的细胞学分析诊断敏感性约为60%。已经提出了几种检测方法来改善诊断，其中包括胸腔积液中肿瘤标志物的浓度。我们评估了在细胞学结果存疑时，胸腔积液中肿瘤标志物的浓度是否能改善恶性胸腔积液（mpe）的诊断。
对156例门诊患者因结核病或恶性肿瘤继发的淋巴细胞性胸腔积液进行细胞学检查和肿瘤标志物定量分析[癌胚抗原（cea）、癌抗原15-3（ca15-3）、糖类抗原19-9（ca19-9）、癌抗原72-4（ca72-4）、癌抗原125（ca125）和细胞角蛋白19片段（cyfra 21-1）]。统计分析采用单因素方差分析、学生t检验或曼-惠特尼检验以及受试者工作特征曲线。
无论细胞学结果如何，mpe中肿瘤标志物cea、ca15-3、ca125和cyfra 21-1的浓度均高于良性胸腔积液（p<0.001）。ca19-9和ca72-4这两种标志物无法区分恶性和良性胸腔积液。当比较细胞学检查为阳性、可疑或阴性的mpe中肿瘤标志物的浓度与良性胸腔积液中的浓度时，我们观察到细胞学检查为阳性的恶性胸腔积液中cea、ca15-3、cyfra 21-1和ca125的水平更高（分别为p = 0.003、p = 0.001、p = 0.002和p = 0.001）。在胸腔积液中，细胞学检查为可疑或阴性的mpe中只有ca125高于良性胸腔积液（p = 0.001）。
鉴于肿瘤标志物浓度具有较高的特异性和约60%的敏感性，对于恶性肿瘤预测概率高或有癌症病史且细胞学检查结果不确定的患者，可评估胸腔积液中肿瘤标志物的浓度。
