San Jose M E, Alvarez D, Valdes L, Sarandeses A, Valle J M, Penela P
Department of Biochemistry, Hospital de Conxo (Complejo Hospitalario Universitario de Santiago), La Coruña, Spain.
Clin Chim Acta. 1997 Sep 30;265(2):193-205. doi: 10.1016/s0009-8981(97)00120-4.
Approximately 20% of pleural effusions are caused by neoplastic processes. Although cytology is the most specific routine diagnostic procedure, its sensitivity of 50-60% is insufficient, and thus diagnosis is usually carried out by more invasive techniques such as pleural biopsy, thoracoscopy or thoracotomy. The object of this study is to evaluate the use of determining some tumour markers in pleural fluid obtained by thoracocentesis for diagnosis of neoplastic pleural effusion. Patients (271) with pleural effusions were classified in five groups: I: neoplasms n = 88; II: tuberculosis n = 63; III: parapneumonics n = 53; IV: miscellaneous exudates n = 39 and V: transudates n = 28. The tumour markers studied were: carcinoembryonic antigen (CEA), CA 125, squamous cell carcinoma antigen (SCC), and neuron specific enolase (NSE). The tumour makers had the following diagnostic efficiencies for neoplastic origin of the pleural effusion: CEA 76% (sensitivity 31%, specificity 93%); CA 125 66% (70% and 61%); SCC 65% (48% and 80%) and NSE 53% (30% and 89%). The diagnostic efficiencies for pulmonary neoplastic origins were 68% for NSE (sensitivity 83%, specificity 53%); 65% for SCC (54% and 75%); 63% for CEA (80% and 48%) and 61% for CA 125 (79% and 42%). We believe that the routine testing of tumour markers in pleural fluid obtained by thoracocentesis would greatly increase diagnostic effectiveness and could avoid the practice of more aggressive diagnostic techniques on the patient.
约20%的胸腔积液由肿瘤性病变引起。虽然细胞学检查是最具特异性的常规诊断方法，但其50 - 60%的敏感性不足，因此通常通过更具侵入性的技术如胸膜活检、胸腔镜检查或开胸手术来进行诊断。本研究的目的是评估在通过胸腔穿刺术获取的胸腔积液中测定某些肿瘤标志物用于诊断肿瘤性胸腔积液的应用情况。271例胸腔积液患者被分为五组：I组：肿瘤患者n = 88；II组：结核病患者n = 63；III组：类肺炎性胸腔积液患者n = 53；IV组：其他渗出液患者n = 39；V组：漏出液患者n = 28。所研究的肿瘤标志物有：癌胚抗原（CEA）、CA 125、鳞状细胞癌抗原（SCC）和神经元特异性烯醇化酶（NSE）。这些肿瘤标志物对胸腔积液肿瘤性起源的诊断效率如下：CEA为76%（敏感性31%，特异性93%）；CA 125为66%（70%和61%）；SCC为65%（48%和80%）；NSE为53%（30%和89%）。对肺肿瘤性起源的诊断效率为：NSE为68%（敏感性83%，特异性53%）；SCC为65%（54%和75%）；CEA为63%（80%和48%）；CA 125为61%（79%和42%）。我们认为，对通过胸腔穿刺术获取的胸腔积液进行肿瘤标志物的常规检测将大大提高诊断效率，并可避免对患者采用更具侵袭性的诊断技术。
