Trapé Jaume, Sant Francesc, Franquesa Josefina, Montesinos Jesús, Arnau Anna, Sala Maria, Bernadich Oscar, Martín Esperanza, Perich Damià, Pérez Concha, Lopez Joan, Ros Sandra, Esteve Enrique, Pérez Rafael, Aligué Jordi, Gurt Gabriel, Catot Silvia, Domenech Montserrat, Bosch Joan, Badal Josep Miquel, Bonet Mariona, Molina Rafael, Ordeig Josep
Department of Laboratory Medicine, Althaia Xarxa Assistencial Universitària de Manresa, Dr Joan Soler 1-3, 08243, Manresa, Catalonia, Spain.
Department of Pathology, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Catalonia, Spain.
Respir Res. 2017 May 25;18(1):103. doi: 10.1186/s12931-017-0582-1.
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.
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.
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.
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.
胸腔积液的诊断具有挑战性。约20%的胸腔积液与癌症相关，约50%需要进行侵入性检查来明确诊断。肿瘤标志物的测定有助于识别恶性胸腔积液患者。在恶性胸腔积液的鉴别诊断中，有两种策略用于获得高特异性：a）高临界值，b）胸水/血清（F/S）比值及低临界值。本研究的目的是比较这两种策略，并确定使用良性生物标志物（腺苷脱氨酶、C反应蛋白和多形核细胞百分比）识别可能的假阳性结果是否能提高诊断准确性。
我们研究了402例胸腔积液，其中122例为恶性。测定了胸水的良性生物标志物以及胸水和血清中的癌胚抗原、CA72 - 4、CA19 - 9和CA15 - 3。
为使每种肿瘤标志物的特异性达到100%而设定临界值时，联合敏感度为66.5%。采用F/S策略和低临界值时，敏感度为77%，特异性为98.2%。将良性生物标志物为阴性的病例进行亚分类后，两种策略的特异性均达到100%；单项测定的敏感度为69.9%，F/S比值的敏感度为80.6%。
在良性生物标志物为阴性的组中，采用F/S比值对肿瘤标志物在恶性胸腔积液鉴别诊断中的结果进行解读最佳。
