Diagnostic usefulness of tumour marker levels in pleural effusions of malignant and benign origin

Our plain-English summary of Diagnostic usefulness of tumour marker levels in pleural effusions of malignant and benign origin, by F. Kuralay, Z. Tokgöz, A. Cömlekci (Clinica Chimica Acta; International Journal of Clinical Chemistry, 2000).

The study

• Authors: F. Kuralay, Z. Tokgöz, A. Cömlekci
• Journal: Clinica Chimica Acta; International Journal of Clinical Chemistry
• Published: 2000;300(1-2):43-55
• Cited by: 30 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Pleural effusion is a common diagnostic problem. The analysis of serum and body fluids for tumor markers has been intensively applied to clinical diagnosis. The aim of the present study was to determine the usefulness of simultaneous quantification of carbohydrate antigen 19.9, carbohydrate antigen 125, neuron specific enolase, mucinous-carcinoma-associated antigen, and ferritin in samples of pleural fluids in the malign pleural effusion and its differentiation from benign effusions. A total of 61 pleural effusions were collected from the patients, who were subjected either to simple needle aspiration or to tube drainage for the diagnosis of pleural effusion. Tumor markers were determined in benign patient groups with nonspecific pleurisy, tuberculous pleurisy, empyema, congestive heart failure and in malignancy groups consisting of adenocarcinoma, small cell lung carcinoma, mesothelioma, epidermoid lung cancer. The tumor markers CA-19.9, CA-125, NSE, and ferritin levels were quantified by the sandwich assay using the streptavidin technology of ELISA in an ES-300 Boehringer-Mannheim analyser. MCA was measured by employing a two-side solid phase EIA method. MCA measurements were done by the Cobas-Core. For all patients, the effusions correctly or incorrectly identified by the different procedures as being malignant or nonmalignant are defined as true positive, false positive, true negative, and false negative, the term 'positive' referring to histologically proven malignant pleural effusion while nonmalignant effusions are referred to as 'negative'. Therefore, sensitivity, specificity, positive predictive value, and negative predictive value were defined as diagnostic parameters. The cut-off values calculated were 352 U/ml for CA-125, 54 U/ml for CA-19.9, 555 for ferritin, 11.1 for MCA and 8.7 for NSE. In our study, the highest sensitivity is found to be MCA with 100%; specificity, CA-19.9 with 97%; PPV, CA-19.9 and MCA with 95% and NPV, MCA with 100%. Our data imply that the co-measurement of MCA+CA-19.9+CA-125 levels may further improve their diagnostic value in malignant pleural effusion compared with that of each tumour marker alone and may be useful in distinguishing malignant from benign pleural effusions.

In plain English

This study, from Dokuz Eylul University Hospital in Izmir, Turkey, tested whether five tumour markers measured in pleural fluid could help tell malignant from benign pleural effusions. The markers were CA-19.9, CA-125, neuron specific enolase (NSE), mucinous-carcinoma-associated antigen (MCA) and ferritin. Fluid was collected between November 1996 and May 1997. The patients were 42 with benign conditions (nonspecific pleurisy, tuberculous pleurisy, empyema, congestive heart failure) and 19 with stage IV malignancies (adenocarcinoma, small cell lung carcinoma, epidermoid lung cancer, and mesothelioma in 4 patients). Pleural biopsy was the reference standard. All five markers were significantly higher in malignant than in benign effusions. The text reported sensitivity of 100% for MCA, 95% for CA-125 and 90% for CA-19.9, and specificities between 95 and 97% for all markers. MCA was significantly higher in the mesothelioma group than in the other groups. Some false positive results occurred in tuberculous pleurisy and empyema. The authors concluded that measuring MCA, CA-19.9 and CA-125 together may help diagnose malignant effusions. Some figures in the article disagree with each other. Asbestos exposure was not examined.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: diagnostic study comparing tumour marker levels in pleural fluid against pleural biopsy as the reference standard
• Who was studied: 61 pleural effusions from patients at Dokuz Eylul University Hospital, Izmir, Turkey, November 1996 to May 1997. The 42 benign cases were nonspecific pleurisy (12), tuberculous pleurisy (12), empyema (8) and congestive heart failure (10). The 19 malignant cases, all stage IV, were adenocarcinoma (8), small cell lung carcinoma (4), mesothelioma (4) and epidermoid lung cancer (3).
• Exposure: No asbestos or fiber exposure was studied. The study measured five tumour markers in pleural fluid: CA-19.9, CA-125, NSE, MCA and ferritin.
• Main results:
  • Cut-off values, set from the benign group, were 352 U/ml for CA-125, 54 U/ml for CA-19.9, 555 for ferritin, 11.1 for MCA and 8.7 for NSE.
  • All five markers were significantly higher in malignant than in benign effusions.
  • In the Results text, sensitivity was 95% for CA-125, 90% for CA-19.9 and 100% for MCA, compared with 52% for NSE and 61% for ferritin. Specificities of all markers were between 95 and 97%.
  • The combination of MCA, CA-125 and CA-19.9 (at least one marker positive) had sensitivity 100%, specificity 97%, negative predictive value 100% and positive predictive value 97% (Table 2).
  • MCA levels in the mesothelioma group were significantly higher than in the other malignant and benign groups.
  • NSE levels were significantly raised in small cell lung carcinoma, while the mesothelioma group showed no significant differences.
  • False positive results occurred in tuberculous pleurisy (CA-125, MCA, NSE) and empyema (CA-19.9, ferritin). None occurred in congestive heart failure or nonspecific pleurisy.
• The authors' conclusion: The authors concluded that measuring MCA, CA-19.9 and CA-125 together, and to some degree NSE and ferritin, may help diagnose malignant pleural effusion and distinguish it from benign cases.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Pleural Effusion, Tumor Marker, Carcinoma, Ferritin, Pleurisy, Tuberculous pleurisy, Empyema, Adenocarcinoma.

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