Evaluation of predictive value of pleural CEA in patients with pleural effusions and histological findings: A prospective study and literature review

Our plain-English summary of Evaluation of predictive value of pleural CEA in patients with pleural effusions and histological findings: A prospective study and literature review, by R. Tozzoli, S.M. Basso, F. D'Aurizio, et al (Clinical Biochemistry, 2016).

The study

• Authors: R. Tozzoli, S.M. Basso, F. D'Aurizio, P. Metus, F. Lumachi
• Journal: Clinical Biochemistry
• Published: 2016;49(16-17):1227-1231
• Type of article: Review
• Cited by: 21 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objectives: Pleural effusion recognizes heterogeneous etiology and pathogenesis and requires invasive diagnostic procedures. Usually, after pleural fluid analysis, 30-50% of patients with malignant pleural effusion exhibit negative pleural cytology, and the sensitivity of image-guided pleural needle-aspiration biopsy ranges between 60% and 70%. With the aim of differentiating between benign (BPE) and malignant (MPE) pleural effusions, several tumor markers have been assayed in the pleural fluid and the majority of studies focus on pleural carcinoembryonic antigen (p-CEA). The aims of this study were to evaluate (i) the diagnostic accuracy of p-CEA of patients with pleural effusions undergoing video-assisted thoracoscopic surgery (VATS) for diagnostic purpose, (ii) the relationship between p-CEA and serum CEA (s-CEA), and (iii) the usefulness of the p-CEA/s-CEA ratio in the diagnosis of malignant pleural effusions (MPE).

Design & Methods: We prospectively enrolled in the study 134 consecutive patients with pleural effusions, scheduled for having VATS and biopsy. The final diagnosis, based on histopathology of the VATS-guided specimens, was available for all patients. p-CEA and s-CEA was assayed with a chemiluminescence immunoassay method (CLIA), applied on the Maglumi 2000 Plus automated platform (SNIBE, Shenzen, China).

Results: The sensitivity and accuracy of p-CEA was significantly higher than that of pleural cytology at the same specificity comparing BPE with MPE and BPE with non-small lung cancer. The sensitivity of p-CEA and PC together reached 100% (BPE vs. NSCLC) and 91.5% (BPE vs. MPE excluding mesothelioma), respectively.

Conclusions: The p-CEA measurement in patients with pleural effusion of uncertain etiology is a safe and cost-effective procedure, everywhere easily available, which may help clinicians in selecting patients for further evaluations. An elevated p-CEA level in a patient with pleural effusion and negative pleural cytology suggests the need of more invasive procedure (e.g. VATS-guided biopsies), whilst low p-CEA may support a follow-up.

Copyright © 2016 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

In plain English

This prospective Italian study tested whether measuring carcinoembryonic antigen (CEA), a tumor marker, in fluid around the lungs (pleural effusion) helps distinguish cancer-related from benign effusions. It enrolled 134 consecutive patients due for video-assisted thoracoscopic surgery and biopsy. Biopsy showed 90 malignant effusions (37 non-small-cell lung cancer, 34 lung metastases, 19 pleural mesotheliomas) and 44 benign. At a 5 ng/mL cut-off, pleural CEA was more sensitive than pleural cytology at equal specificity (97.7%). For malignant effusions excluding mesothelioma, sensitivity was 74.6% (95% confidence interval 64.5 to 84.8) for pleural CEA versus 53.5% (41.9 to 65.2) for cytology. For non-small-cell lung cancer it was 97.3% (84.2 to 99.8) versus 64.9% (49.5 to 80.2). Together, the two tests reached 91.5% sensitivity for malignant effusions excluding mesothelioma and 100% for non-small-cell lung cancer. In patients with mesothelioma, the sensitivity of both tests was below 50%. The authors judged blood CEA not useful, citing low accuracy. The authors concluded that pleural CEA is a safe, cost-effective test that may help select patients for further evaluation. The study did not examine asbestos exposure.

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: Prospective diagnostic accuracy study comparing pleural CEA, serum CEA and pleural cytology against biopsy findings, with a table of earlier published reports on pleural CEA
• Who was studied: 134 consecutive patients with pleural effusion scheduled for VATS and biopsy (83 men, 51 women; median age 71, range 40 to 89). Patients with relapse after previous thoracentesis, or with effusion due to heart failure, were excluded. The authors are from S. Maria degli Angeli Hospital in Pordenone and the University of Padua School of Medicine, Italy. Enrollment dates are not given.
• Main results:
  • Final tissue diagnosis was malignant effusion in 90 patients (37 non-small-cell lung cancer, 34 lung metastases, 19 pleural mesotheliomas) and benign in 44.
  • The optimal cut-off for both pleural and serum CEA was 5 ng/mL. At this cut-off, pleural CEA had an AUC of 0.864, sensitivity of 71.0% and specificity of 94.7%. Serum CEA had an AUC of 0.491.
  • Malignant effusions excluding mesothelioma (N = 71) versus benign effusions (N = 44): at the same specificity of 97.7%, sensitivity was 74.6% (95% confidence interval 64.5 to 84.8) for pleural CEA and 53.5% (41.9 to 65.2) for pleural cytology.
  • Non-small-cell lung cancer (N = 37) versus benign effusions (N = 44): sensitivity was 97.3% (95% confidence interval 84.2 to 99.8) for pleural CEA and 64.9% (49.5 to 80.2) for pleural cytology. Accuracy was 97.5% versus 82.7%.
  • Pleural CEA and cytology together reached 100% sensitivity for non-small-cell lung cancer versus benign effusions, and 91.5% for malignant effusions excluding mesothelioma versus benign effusions. Specificity did not change.
  • In patients with mesothelioma (19 patients), the sensitivity of both pleural CEA and pleural cytology was below 50%.
  • No relationship was found between a positive cytology result and a positive pleural CEA result (R = 0.0475, p = 0.5857).
  • The authors' table of earlier published reports showed pleural CEA sensitivity ranging from 27 to 87.2% and specificity from 77 to 98.6%. The authors attributed this spread to differing cut-offs and detection methods.
• The authors' conclusion: The authors concluded that measuring pleural CEA in patients with pleural effusion of uncertain cause is a safe, cost-effective and widely available procedure that may help clinicians select patients for further evaluation. They also concluded that serum CEA is not useful because of its low accuracy, and that the combination of pleural CEA and cytology should be used before further invasive investigations.

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, Etiology, Cytology, Biopsy, Tumor Marker, Carcinoembryonic Antigen (CEA), Video-Assisted Thoracoscopic Surgery (VATS), Histopathology.

Related studies

• Evaluation of pleural CYFRA 21-1 and carcinoembryonic antigen in the diagnosis of malignant pleural effusions — G. Salama, M. Miédougé, et al. (1998)
• Value of immunocytochemistry in the study of malignant effusions — M.R. Mason, C.W. Bedrossian, et al. (1987)
• The value of anti-calretinin antibody in the differential diagnosis of normal and reactive mesothelia versus metastatic tumors in effusion cytology — H. Nagel, B. Hemmerlein, et al. (1998)
• Evolution of idiopathic pleural effusion: a prospective, long-term follow-up study — J.S. Ferrer, X.G. Muñoz, et al. (1996)
• Re-evaluation of histological findings of nonparasitic splenic cysts — P. Vajda, L. Kereskai, et al. (2012)
• Significance of secretory leukocyte peptidase inhibitor in pleural fluid for the diagnosis of benign asbestos pleural effusion — T. Kishimoto, Y. Kojima, et al. (2021)

Browse return to medical research.