Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, 610041, China.
BMC Cancer. 2017 Aug 30;17(1):590. doi: 10.1186/s12885-017-3572-2.
Neuron-Specific enolase (NSE) has been used as a typical tumor marker and shows a potential to diagnose malignant pleural effusion (MPE). The ability of NSE in diagnosing MPE has been investigated in many studies, but with inconsistent conclusions. This study sought to investigate the diagnostic accuracy of NSE for MPE through a clinical study and together with a meta-analysis.
Pleural effusion samples from 136 patients with MPE and 102 patients with benign pleural effusion (BPE) were collected, and NSE levels were measured by electrochemiluminescence immunoassay. Receiver operating characteristic (ROC) curve analysis was performed to assess the ability of NSE to differentiate MPE from BPE. Literature search was conducted to identify suitable publications, data were extracted and diagnostic indexes including sensitivity, specificity, positive/negative likelihood ratio (PLR/NLR), and diagnostic odds ratio (DOR) were pooled. Summary ROC curve was generated to determine the overall diagnostic accuracy of NSE for MPE.
Levels of NSE were significantly increased in pleural effusion from patients with MPE than that from BPE (18.53 ± 27.30 vs. 6.41 ± 6.95 ng/ml, p < 0.001). With a cut-off value of 8.92 ng/ml, pleural NSE had a sensitivity of 59.56% and a specificity of 83.33% in diagnosing MPE. A total of 14 studies with 1896 subjects were included for meta-analysis. The diagnostic parameters of NSE were listed as follows: sensitivity, 0.53 (95% CI: 0.38-0.67); specificity, 0.85 (95% CI: 0.75-0.91); PLR, 3.54 (95% CI: 2.33-5.39); NLR, 0.56 (95% CI: 0.42-0.73); and DOR, 6.39 (95% CI: 3.72-10.96). The area under the summary ROC curve was 0.78.
The role of pleural NSE measurement in diagnosing MPE is limited and with a low sensitivity. The clinical utility of NSE assay should be combined with the results of other tumor markers examination and the detail clinical information of patient. Further studies are needed to confirm the role of NSE in diagnosing MPE.
神经元特异性烯醇化酶（NSE）已被用作典型的肿瘤标志物，具有诊断恶性胸腔积液（MPE）的潜力。许多研究已经探讨了 NSE 诊断 MPE 的准确性，但结论不一致。本研究通过临床研究和荟萃分析来探讨 NSE 对 MPE 的诊断准确性。
收集了 136 例 MPE 患者和 102 例良性胸腔积液（BPE）患者的胸腔积液样本，并通过电化学发光免疫分析法测量 NSE 水平。进行受试者工作特征（ROC）曲线分析，以评估 NSE 区分 MPE 和 BPE 的能力。进行文献检索以确定合适的出版物，提取数据，并汇总灵敏度、特异性、阳性/阴性似然比（PLR/NLR）和诊断比值比（DOR）等诊断指标。生成汇总 ROC 曲线以确定 NSE 对 MPE 的总体诊断准确性。
MPE 患者胸腔积液中的 NSE 水平明显高于 BPE 患者（18.53±27.30 与 6.41±6.95ng/ml，p<0.001）。当截断值为 8.92ng/ml 时，胸腔 NSE 对 MPE 的诊断灵敏度为 59.56%，特异性为 83.33%。共纳入 14 项研究，共计 1896 例患者进行荟萃分析。NSE 的诊断参数如下：灵敏度为 0.53（95%置信区间：0.38-0.67）；特异性为 0.85（95%置信区间：0.75-0.91）；PLR 为 3.54（95%置信区间：2.33-5.39）；NLR 为 0.56（95%置信区间：0.42-0.73）；DOR 为 6.39（95%置信区间：3.72-10.96）。汇总 ROC 曲线下面积为 0.78。
胸腔 NSE 测量在诊断 MPE 中的作用有限，且灵敏度较低。NSE 检测的临床应用应结合其他肿瘤标志物检查结果和患者的详细临床信息。需要进一步研究来证实 NSE 在诊断 MPE 中的作用。
