Study objective: The aim of our study was to assess the
clinical value of CYFRA 21–1 tumor marker and carcinoembryonic antigen
(CEA) as diagnostic tools that are complementary to cytology in the
diagnosis of malignant mesotheliomas.
measured CEA and CYFRA 21–1 in the pleural effusions (PEs) and serum
of 106 patients (benign lung disease, 34 patients; bronchogenic and
metastatic carcinoma, 40 patients; mesothelioma, 32 patients).
Methods: CEA and CYFRA 21–1 levels were determined by
means of two commercial enzyme immunoassays.
The cutoff levels of CYFRA 21–1 and CEA in malignant PEs,
selected on the basis of the best diagnostic efficacy, were 41.9 ng/mL
and 5.0 ng/mL, respectively. In all neoplastic PEs, CYFRA 21–1 and CEA
sensitivity was 78% and 30.6%, respectively, with a specificity of
80% and 91%, respectively. The sensitivity of CYFRA 21–1 and CEA in
patients with mesothelioma was 87.5% and 3.1%, respectively. The
results of the CYFRA 21–1 assay were positive in 17 of 19 cases of
mesothelioma (89.5%) with a negative or uncertain cytology. The
association of the tumor marker assay and the cytology allowed a
correct diagnosis in 30 of 32 cases of mesothelioma (93.7%).
Conclusion: This study suggests that CYFRA 21–1 would
provide a useful parameter for the differential diagnosis between
benign and malignant PE from mesothelioma when the result of cytology
is negative or uncertain and the clinical context does not allow a more
aggressive approach. Moreover, the association of CYFRA 21–1 with CEA
could provide details for a differential diagnosis between
mesotheliomas and carcinomas. In fact, an elevated CYFRA 21–1 level
with a low CEA level is highly suggestive of mesothelioma, whereas high
levels of CEA alone or high levels of both the markers suggest a
diagnosis of malignant PE, excluding mesothelioma.