title: Diagnostic value of carcinoembryonic antigen in malignant pleural effusion: a meta-analysis.
abstract: OBJECTIVE
  Conventional tests are not always helpful in making a diagnosis of malignant pleural effusion (MPE). Many studies have investigated the utility of pleural carcinoembryonic antigen (CEA) in the early diagnosis of MPE. The present meta-analysis determined the accuracy of CEA measurement in the diagnosis of MPE.
  
  
  METHODS
  A systematic review of English language studies was conducted and data on the accuracy of pleural CEA concentrations in the diagnosis of MPE were pooled using random effects models. Receiver operating characteristic curves were used to summarize the overall test performance.
  
  
  RESULTS
  Forty-five studies met the inclusion criteria for the meta-analysis. The summary estimates for CEA in the diagnosis of MPE were: sensitivity 0.54 (95% CI: 0.52-0.55), specificity 0.94 (95% CI: 0.93-0.95), positive likelihood ratio 9.52 (95% CI: 6.97-13.01), negative likelihood ratio 0.49 (95% CI: 0.44-0.54) and diagnostic odds ratio 22.5 (95% CI: 15.6-32.5). Analysis of a subset of 11 studies which examined the value of pleural CEA in ruling out a diagnosis of malignant mesothelioma found that the sensitivity and specificity of a CEA level exceeding cut-off values were 0.97 (95% CI: 0.93-0.99) and 0.60 (95% CI: 0.55-0.65), respectively.
  
  
  CONCLUSIONS
  Measurement of pleural CEA is likely to be a useful diagnostic tool for confirming MPE, and is also helpful in the differential diagnosis between malignant pleural mesothelioma and metastatic lung cancer. The results of CEA assays should be interpreted in parallel with clinical findings and the results of conventional tests.
authors.affiliation: Institute of Respiratory Diseases, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China. shihuanzhong@sina.com
authors.forename: Huan-Zhong
authors.initials: HZ
authors.lastname: Shi
authors.forename: Qiu-Li
authors.initials: QL
authors.lastname: Liang
authors.forename: Jing
authors.initials: J
authors.lastname: Jiang
authors.forename: Xue-Jun
authors.initials: XJ
authors.lastname: Qin
authors.forename: Hai-Bo
authors.initials: HB
authors.lastname: Yang
mesh_terms: D002272:Carcinoembryonic Antigen / Q000378:metabolism*; D006801:Humans; D007150:Immunohistochemistry; D008175:Lung Neoplasms / Q000175:diagnosis / Q000378:metabolism; D008654:Mesothelioma / Q000175:diagnosis / Q000378:metabolism; D016066:Pleural Effusion, Malignant / Q000175:diagnosis* / Q000378:metabolism*; D012372:ROC Curve; D012680:Sensitivity and Specificity
chemical_list: D002272:Carcinoembryonic Antigen