癌胚抗原在渗出性胸腔积液患者胸腔积液中的诊断价值

Diagnostic utility of pleural fluid carcinoembryonic antigen in patients with exudative pleural effusion.

作者信息

Krishnan Vishnu G, Kunoor Akhilesh, Keechilath Pavithran, Mehta Asmita Anilkumar

机构信息

Department of Respiratory Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India.

Department of Medical Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.

出版信息

Lung India. 2021 Mar-Apr;38(2):139-143. doi: 10.4103/lungindia.lungindia_196_20.

DOI:10.4103/lungindia.lungindia_196_20

PMID:33687007

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8098895/

Abstract

BACKGROUND

Pleural effusion (PE) is presenting symptoms of many different diseases and is often a diagnostic challenge. Negative cytology in the malignant PE requires more complicated diagnostic procedures, such as closed pleural biopsy or thoracoscopic pleural biopsy. Not all the patients will be fit for such invasive procedures due to high risk. Tumor markers seem to be a promising alternative and have been proposed to aid in the differentiation of the PE etiology.

OBJECTIVE

The objective of the study was to evaluate the diagnostic value of pleural fluid carcinoembryonic antigen (CEA) in differentiation between malignant and nonmalignant PEs and to compare adenosine deaminase (ADA) levels with respect to malignant and nonmalignant PE.

METHODOLOGY

It was a prospective observational study. Patients who presented with undiagnosed exudative PE during the time period 2016-2018 were studied. Pleural fluid was subjected to all routine investigations such as sugar, protein, lactate dehydrogenase, ADA, and CEA.

RESULTS

A total of 100 patients were included in the study. Fifty-one patients had malignancy. Univariate analysis showed that smoker, previous history of cancer, ADA <20, and CEA of >2.15 were variables associated with malignancy. Multivariate analysis showed pleural fluid CEA >2.15 as only independent risk factor associated with malignancy. The sensitivity of 91.5% and 65% and specificity of 92.5% and 81.4%, respectively, were found for CEA 2.15 ng/dl and ADA <16.5 U/L as plotted from receiver operating characteristic curve. The combined CEA and ADA (2.39 ng/ml and 16.5 U/L) values in pleural fluid had higher sensitivity of 100%.

CONCLUSION

Our study demonstrated that pleural fluid CEA levels have a sensitivity of 93.5% and specificity of 73% in diagnosing of malignant PE. ADA levels lesser than 16.5 U/L were seen in patients with malignant PE, but less sensitive and specific compared to CEA. Combined ADA and CEA levels had higher sensitivity than CEA alone.

摘要

背景

胸腔积液（PE）是多种不同疾病的症状表现，常常是一个诊断难题。恶性胸腔积液的细胞学检查结果为阴性时，需要更复杂的诊断程序，如闭式胸膜活检或胸腔镜胸膜活检。由于风险高，并非所有患者都适合进行此类侵入性检查。肿瘤标志物似乎是一种有前景的替代方法，已被提议用于辅助鉴别胸腔积液的病因。

目的

本研究的目的是评估胸腔积液癌胚抗原（CEA）在鉴别恶性和非恶性胸腔积液中的诊断价值，并比较恶性和非恶性胸腔积液中腺苷脱氨酶（ADA）的水平。

方法

这是一项前瞻性观察性研究。对2016年至2018年期间出现未确诊渗出性胸腔积液的患者进行了研究。对胸腔积液进行了所有常规检查，如血糖、蛋白质、乳酸脱氢酶、ADA和CEA。

结果

共有100名患者纳入研究。51名患者患有恶性肿瘤。单因素分析显示，吸烟者、既往癌症史、ADA<20以及CEA>2.15是与恶性肿瘤相关的变量。多因素分析显示，胸腔积液CEA>2.15是与恶性肿瘤相关的唯一独立危险因素。根据受试者工作特征曲线绘制，CEA 2.15 ng/dl和ADA<16.5 U/L的敏感性分别为91.5%和65%，特异性分别为92.5%和81.4%。胸腔积液中CEA和ADA的联合值（2.39 ng/ml和16.5 U/L）具有更高的敏感性，为100%。