胸腔积液MAGE RT嵌套式PCR在恶性胸腔积液诊断中的作用

The role of pleural fluid MAGE RT-nested PCR in the diagnosis of malignant pleural effusion.

作者信息

Jeon Eun Ju, Park Hye Kyeong, Jeon Kyeongman, Koh Won-Jung, Suh Gee Young, Chung Man Pyo, Kim Hojoong, Kwon O Jung, Ki Chang-Seok, Kim Jong-Won, Shim Young Mog, Um Sang-Won

机构信息

Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, KoreaDepartment of Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, KoreaDepartment of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, KoreaDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Korea.

出版信息

Thorac Cancer. 2012 Nov;3(4):320-325. doi: 10.1111/j.1759-7714.2012.00131.x.

DOI:10.1111/j.1759-7714.2012.00131.x

PMID:28920277

Abstract

BACKGROUND

Melanoma antigen (MAGE) genes are expressed in tumor cells, the testis and the placenta. The purpose of this prospective study was to investigate the sensitivity, specificity, and accuracy of the carcinoembryonic antigen (CEA), MAGE reverse transcriptase-nested polymerase chain reaction (RT-nested PCR), and cytology of pleural fluid in the diagnosis of malignant pleural effusion.

METHODS

Patients in whom unilateral pleural effusion was identified on chest radiography from January to December 2009 were included in the study. MAGE genes were analyzed by RT-nested PCR using MAGE A1-6 common primers.

RESULTS

Of 81 enrolled patients, 46 were diagnosed as malignant pleural effusion, and 24 were diagnosed as benign pleural effusion. The diagnoses of 11 patients were not confirmed in this study. The diagnostic sensitivity, specificity, and accuracy of MAGE RT-nested PCR were 61.4%, 95.7%, and 73.1%, respectively. The diagnostic sensitivities of cytology and CEA (>5 ng/mL) were 61.4% and 75.0%, respectively. Among 17 patients with negative cytology who had malignant pleural effusion, 12 and 10 patients were positive for CEA (>5.0 ng/mL) and MAGE RT-nested PCR, respectively. However, of five patients with malignant pleural effusion that was not recognized by cytology and CEA, MAGE RT-nested PCR correctly predicted a malignant etiology in only one additional patient (20%).

CONCLUSIONS

MAGE RT-nested PCR seems to add little on the combination of conventional methods in the diagnosis of malignant effusion.

摘要

背景

黑色素瘤抗原（MAGE）基因在肿瘤细胞、睾丸和胎盘中表达。本前瞻性研究的目的是探讨癌胚抗原（CEA）、MAGE逆转录巢式聚合酶链反应（RT - 巢式PCR）及胸水细胞学检查在诊断恶性胸腔积液中的敏感性、特异性和准确性。

方法

纳入2009年1月至12月胸部X线检查发现单侧胸腔积液的患者。使用MAGE A1 - 6通用引物通过RT - 巢式PCR分析MAGE基因。

结果

81例纳入研究的患者中，46例被诊断为恶性胸腔积液，24例被诊断为良性胸腔积液。本研究中11例患者的诊断未得到证实。MAGE RT - 巢式PCR的诊断敏感性、特异性和准确性分别为61.4%、95.7%和73.1%。细胞学检查和CEA（>5 ng/mL）的诊断敏感性分别为61.4%和75.0%。在17例细胞学检查阴性但有恶性胸腔积液的患者中，CEA（>5.0 ng/mL）和MAGE RT - 巢式PCR分别有12例和10例呈阳性。然而，在5例细胞学检查和CEA均未识别出的恶性胸腔积液患者中，MAGE RT - 巢式PCR仅在另外1例患者（20%）中正确预测了恶性病因。