Use of tumor markers for differential diagnosis of mesothelioma and secondary pleural malignancies.
OBJECTIVE
The aim of the study was to assess diagnosis value of tumor markers for differential diagnosis between mesothelioma and other pleural tumors.


METHODS
Prospective study of 85 patients attending our hospital with malignant pleural effusion. The diagnostic approach involved routine pleurocentesis followed by pleural needle. When precise diagnosis was not achieved, thoracoscopy with pleural biopsies was performed. Carcinoembryonic antigen (CEA), hyaluronic acid, tissue polypeptide antigen and cyfra 21 to 1 were measured in serum and pleural fluid.


RESULTS
By using receiver operating characteristics curves and area under curves, the best diagnostic characteristics were obtained with pleural and serum CEA concentrations. The area under the curve was larger for pleural ACE than for serum ACE. The sensitivity and specificity of a pleural CEA level exceeding 3 ng/mL for ruling out the diagnosis of mesothelioma were 100% and 77%, respectively.


CONCLUSIONS
A CEA level above 3 ng/mL in pleural fluid eliminated the diagnosis of mesothelioma, whereas the other markers were not sufficiently discriminant. However, despite a negative predictive value of 100% at a cutoff of 3 ng/mL, CEA assay in pleural fluid only avoids a small number of diagnostic thoracoscopies.
Fuhrman
C
C
Service de Pneumologie, Hôpital Intercommunal de Créteil, Créteil, France. claire.fuhrman@chicreteil.fr
Duche
J C
JC
Chouaid
C
C
Abd Alsamad
I
I
Atassi
K
K
Monnet
I
I
Tillement
J P
JP
Housset
B
B
D000230:Adenocarcinoma / Q000175:diagnosis / Q000276:immunology; D000368:Aged; D000951:Antigens, Neoplasm / Q000097:blood; D019540:Area Under Curve; D014408:Biomarkers, Tumor / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood; D018288:Carcinoma, Small Cell / Q000175:diagnosis / Q000276:immunology; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000276:immunology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood / Q000378:metabolism; D053539:Keratin-19; D007633:Keratins; D008175:Lung Neoplasms / Q000175:diagnosis / Q000276:immunology; D008297:Male; D008654:Mesothelioma / Q000175:diagnosis*; D008875:Middle Aged; D010996:Pleural Effusion / Q000276:immunology; D010997:Pleural Neoplasms / Q000175:diagnosis* / Q000556:secondary; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D019396:Tissue Polypeptide Antigen / Q000097:blood
D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen; D053539:Keratin-19; D019396:Tissue Polypeptide Antigen; C102012:antigen CYFRA21.1; D007633:Keratins; D006820:Hyaluronic Acid