Division of Cardiovascular Medicine, Vanderbilt University Medical Center, 1215 21st Avenue - Medical Center East - 5th Floor, Nashville, TN, 37232, USA.
Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
BMC Pulm Med. 2024 Sep 18;24(1):460. doi: 10.1186/s12890-024-03288-z.
Measurement of tumor markers from peripheral venous blood is an emerging tool to assist in the early diagnosis of lung cancer. Samples from the pulmonary artery and pulmonary artery wedge position (trans-pulmonary samples) are accessible via right-heart catheterization and, by virtue of their proximity to lung tumors, may increase diagnostic yield.
We report a case of a 64 year-old woman from whom trans-pulmonary samples were obtained and who was diagnosed 16 months later with recurrent metastatic small cell lung cancer. Carcinoembryonic antigen, cytokeratin fragment 21 - 1 (CYFRA), and human epididymis protein 4 (HE4) levels demonstrated increasing concentrations across the pulmonary circulation. These gradients exceeded the assays' coefficient of variation by several-fold. For CYFRA and HE4, pulmonary artery wedge concentrations exceeded peripheral venous levels by more than 10% and peripheral arterial levels were up to 8% higher than peripheral venous levels.
Evaluating the feasibility and utility of trans-pulmonary tumor markers for lung cancer diagnosis in a larger cohort should be considered. The addition of a peripheral arterial sample to standard peripheral venous samples may be a more practical alternative.
从外周静脉血测量肿瘤标志物是一种新兴的工具，可以帮助早期诊断肺癌。通过右心导管可以获得肺动脉和肺动脉楔位（经肺样本）的样本，由于它们靠近肺肿瘤，因此可能会提高诊断率。
我们报告了一例 64 岁女性的病例，从她那里获得了经肺样本，16 个月后被诊断为复发性转移性小细胞肺癌。癌胚抗原、细胞角蛋白片段 21-1（CYFRA）和人附睾蛋白 4（HE4）的水平在整个肺循环中呈浓度递增。这些梯度超过了测定的变异系数几倍。对于 CYFRA 和 HE4，肺动脉楔位浓度超过外周静脉水平超过 10%，而外周动脉水平比外周静脉水平高 8%。
应考虑在更大的队列中评估经肺肿瘤标志物用于肺癌诊断的可行性和实用性。将外周动脉样本添加到标准外周静脉样本中可能是一种更实用的替代方法。
