The aim of this study was to evaluate the individual and combined diagnostic utility of four tumor markers in patients with pleural effusion.
Operating Characteristics of Each Tumor Marker and Combinations of Tumor Markers in Patients With Pleural EffusionTumor MarkerCutoff%Sensitivity%Specificity%PPV%NPV%AccuracySerumCA 15-329.0759.563.664.758.361NSE10.3638.963.651.146.249CEA2.9547.281.842.626.137CA 12550.655048.55347.250Pleural FluidCA 15 -321.117083.382.471.476NSE5.2168.47574.369.272CEA3.6047.485.378.359.265CA 1251196.6748.670.64234.539CA 15-3+NSE57.591.988.566.774CA 15-3 in serum +71.486.48770.478CA 15-3 in pleural fluidCA 15-3 in serum +76.277.376.377.377NSE in pleural fluidCA 15-3 in serum +CA 15-3 and CEA in pleural fluid8088.988.98084CA 15-3 in serum + CA 15-3 and NSE in pleural fluid76.510010077.887CA 15-3 in serum + CA 15-3, NSE and CEA in pleural fluid8010010081.389
Pleural and serum levels of carcinoembryonic antigen (CEA), carbohydrate antigen 15-3 (CA 15-3), neuron specific enolase (NSE) and cancer antigen 125 (CA 125) were assayed prospectively in 77 patients with pleural effusion (40 malignant and 37 benign).
Using the cutoff values of 29.7 U/ml for CA 15-3, 10.36 μg/L for NSE, 2.95 μg/L for CEA and 50.65 U/ml for CA 125 in serum and cutoff values of 21.11 U/ml, 5.21 μg/L, 3.60 μg/L and 1196.67 U/ml for pleural fluid CA 15-3, NSE, CEA and Ca 125 respectively, the sensitivity (%) and specificity (%) of these tumor markers for differentiating malignant from benign effusions were as follows: in serum CA 15-3 59.5/63.5, NSE 38.9/63.6, CEA 47.2/81.8 and CA 125 50/48.5; and in pleural fluid CA 15-3 70/83.3, NSE 68.4/75, CEA 47.4/85 and CA 125 48.6/70.6. The highest specificity in the diagnosis of pleural malignancy was obtained with combination of CA 15-3 in serum, and CA 15-3 and NSE in pleural fluid and also with combination of CA 15-3 in serum, and CA 15-3, NSE and CEA in pleural fluid and was 100%.The best combination of tumor markers which revealed 100% specificity and 100% PPV with 76.5% sensitivity could be obtained by measurement of CA 15-3 in serum and pleural fluid plus NSE in pleural fluid.
The findings of this study suggest that a combination assay of tumor markers in addition with pleural fluid cytology can use as a diagnostic test in diagnosis of malignant pleural effusion.
The use of combination of CA15-3/NSE/CEA determination in pleural effusion coulld reduce the need for invasive measures in undiagnosed exudative pleural effusions.
Samrad Mehrabi, None.