Evaluation of pleural CYFRA 21-1 and carcinoembryonic antigen in the diagnosis of malignant pleural effusions

Our plain-English summary of Evaluation of pleural CYFRA 21-1 and carcinoembryonic antigen in the diagnosis of malignant pleural effusions, by G. Salama, M. Miédougé, P. Rouzaud, et al (British Journal of Cancer, 1998).

The study

• Authors: G. Salama, M. Miédougé, P. Rouzaud, M.A. Mauduyt, M.C. Pujazon, C. Vincent, P. Carles, G. Serre
• Journal: British Journal of Cancer
• Published: 1998;77(3):472-6
• Cited by: 36 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

CYFRA 21-1 assay, measuring cytokeratin 19 fragments, was compared with carcinoembryonic antigen (CEA) assay, as an addition to cytological analysis for the diagnosis of malignant effusions. Both markers were determined with commercial enzyme immunoassays in pleural fluid from 196 patients. Cytological analysis and/or pleural biopsy confirmed the malignant origin of the effusion in 99 patients (76 carcinomas, nine pleural mesotheliomas and 14 non-epithelial malignancies). Effusions were confirmed as benign in 97 patients (33 cardiac failures, 39 infectious diseases--including 12 tuberculosis-- and 25 miscellaneous effusions). Both markers were significantly higher in malignant than in benign effusions. All the patients with non-epithelial malignancies presented CYFRA and CEA values lower than the 95% diagnostic specificity thresholds (100 and 6 ng ml(-1) respectively). The diagnostic sensitivity in the group of carcinomas and mesotheliomas was similar for CYFRA (58.8%) and CEA (64.7%). However, CEA had a significantly higher sensitivity in carcinomas (72.4% vs 55.3%), while CYFRA had a clearly higher sensitivity in mesotheliomas (89.9% vs 0%). Interestingly, 12 out of the 16 malignant effusions with a negative cytology were CEA and/or CYFRA positive. Regarding their high diagnostic sensitivity and their complementarity, CEA and CYFRA appear to be very useful for the diagnosis of malignant pleural effusions when cytology is negative.

In plain English

This retrospective study from Purpan Hospital, Toulouse, France, measured two markers, CYFRA 21-1 and carcinoembryonic antigen (CEA), in pleural fluid from 196 patients. The aim was to see whether the markers could add to cell examination (cytology) in diagnosing malignant effusions. Cancer was confirmed in 99 patients (76 carcinomas, nine pleural mesotheliomas, 14 non-epithelial malignancies), and 97 had benign effusions. The article did not study asbestos exposure. Cut-offs were set so that 95% of benign effusions tested negative: 6.0 ng per ml for CEA and 100 ng per ml for CYFRA. Both markers were significantly higher in malignant effusions. CEA detected more carcinomas (72.4% vs 55.3%), while CYFRA detected more mesotheliomas (89.9% vs 0%). No non-epithelial malignancy was positive for either marker. Of 16 malignant effusions with negative cytology, 12 were positive for CEA and/or CYFRA. The authors suggested that combining CEA and CYFRA is very useful, particularly when cytology finds no malignant cells and the clinical context is compatible with malignancy. They cautioned that tumour markers may be falsely increased in empyema. They noted that a low-CEA, high-CYFRA pattern is not specific to mesothelioma.

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: retrospective diagnostic study comparing two pleural fluid tumour markers (CEA and CYFRA 21-1) with cytology
• Who was studied: 196 patients with pleural effusions at Purpan Hospital, Toulouse, France. Of these, 99 had malignant effusions (76 carcinomas, nine pleural mesotheliomas, 14 non-epithelial malignancies) and 97 had benign effusions, including two listed as benign asbestosis. Study dates were not given.
• Exposure: Not studied. The article measured tumour markers in pleural fluid and did not report asbestos or other exposures. Two benign effusions were classed as benign asbestosis.
• Main results:
  • The 95% specificity thresholds were 6.0 ng per ml for CEA and 100 ng per ml for CYFRA.
  • Both markers were significantly higher in malignant than in benign effusions.
  • Cytology was positive in 83 of the 99 malignant effusions (sensitivity 83.8%).
  • All patients with non-epithelial malignancies (lymphoma, leukaemia, sarcoma) had CYFRA and CEA values below the thresholds.
  • In carcinomas and mesotheliomas combined, sensitivity was 58.8% for CYFRA and 64.7% for CEA.
  • In carcinomas, CEA sensitivity was 72.4% versus 55.3% for CYFRA (P = 0.04).
  • In the nine mesotheliomas, CYFRA sensitivity was 89.9% versus 0% for CEA (P = 0.0004).
  • Taken together, 73.3% of malignant effusions and 85.5% of carcinoma effusions were positive for at least one marker.
  • Of the 16 malignant effusions with negative cytology, 12 had elevated CEA and/or CYFRA.
  • Cytology, CEA and CYFRA together identified 95 of the 99 malignant effusions.
  • The two highest false-positive values among the benign effusions occurred in empyema.
• The authors' conclusion: The authors suggested that combining CEA and CYFRA is very useful in diagnosing malignant effusions, particularly when cytology does not identify malignant cells and when the clinical context is compatible with a malignancy.
• Limitations the authors state:
  • The groups of small-cell lung carcinomas and squamous cell carcinomas were small.
  • A low-CEA, high-CYFRA pattern suggesting mesothelioma is not specific, because some adenocarcinomas show the same pattern.
  • Tumour markers may be falsely increased in empyema.

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: Carcinoembryonic Antigen (CEA), Pleural Effusion, Pleural Biopsy, Carcinoma, Pleural Mesothelioma, Mesothelioma, Cytology.

Related studies

• Evaluation of seven tumour markers in pleural fluid for the diagnosis of malignant effusions — M. Miédougé, P. Rouzaud, et al. (1999)
• Diagnostic value of mesothelin in pleural fluids: comparison with CYFRA 21-1 and CEA — R. Filiberti, S. Parodi, et al. (2013)
• Lung surfactant protein-A and carcinoembryonic antigen in pleural effusions due to lung adenocarcinoma and malignant mesothelioma — N. Shijubo, Y. Honda, et al. (1995)
• Immunocytological staining reactions of anti-carcinoembryonic antigen, Ca, and anti-human milk fat globule monoclonal antibodies on benign and malignant exfoliated mesothelial cells — A.K. Ghosh, E.B. Butler (1987)
• The distinction of adenocarcinoma from malignant mesothelioma in cell blocks of effusions: the role of routine mucin histochemistry and immunohistochemical assessment of carcinoembryonic antigen, keratin proteins, epithelial membrane antigen, and milk fat globule-derived antigen — E.S. Cibas, J.M. Corson, et al. (1987)
• Mesothelin-related predictive and prognostic factors in malignant mesothelioma: a nested case-control study — O.D. Roe, J. Creaney, et al. (2008)

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