title: Analysis of tumor markers in the cytological fluid obtained from computed tomography-guided needle aspiration biopsy for the diagnosis of non-small cell lung cancer.
abstract: OBJECTIVE
  The aim of this study was to prospectively assess whether analysis of the tumor markers cytokeratin 19 fragments (CYFRA 21-1), carcinoembryonic antigen (CEA), and squamous cell carcinoma (SCC) antigen in cytological fluid can improve the performance of computed tomography (CT)-guided needle aspiration biopsy (NAB) in the diagnosis of non-small cell lung cancer (NSCLC).
  
  
  METHODS
  A total of 100 patients (men:women = 41:59, mean age: 63 years) with suspected malignant pulmonary lesions were prospectively enrolled for CT-guided NAB procedures. Levels of CYFRA 21-1, CEA, and SCC in the cytological fluid were measured by immunoradiometric assays. The cutoff value for tumor markers was selected on the basis of best accuracy through receiver operating characteristic curves. The sensitivity and areas under the curve (AUC) of NAB alone were compared with those of NAB combined with cytological tumor markers (CYFRA 21-1, CEA, and SCC).
  
  
  RESULTS
  Among 100 patients, 71 (71%) had NSCLC and 29 (29%) had benign lesions. The sensitivity, specificity, and accuracy for diagnosing NSCLC were 85.7%, 100%, and 89%, respectively, for NAB alone. The sensitivity increased significantly for NAB combined with a tumor marker compared with NAB alone (100% for CYFRA 21-1, 92.9% for CEA, and 94.2% for SCC; p = 0.001, p = 0.025, and p = 0.014, respectively). The AUC of NAB with CYFRA 21-1 was significantly larger than the AUC of NAB alone (p = 0.001).
  
  
  CONCLUSIONS
  Evaluation of tumor markers CYFRA 21-1, CEA, and SCC in the cytological fluid can improve the diagnostic performance of CT-guided NAB for NSCLC. Of these markers, CYFRA 21-1 is the most useful cytological tumor marker.
authors.affiliation: Department of Radiology and Research Institute of Radiological Science, Seoul, Republic of Korea.
authors.forename: Yoo Jin
authors.initials: YJ
authors.lastname: Hong
authors.forename: Jin
authors.initials: J
authors.lastname: Hur
authors.forename: Hye-Jeong
authors.initials: HJ
authors.lastname: Lee
authors.forename: Ji Eun
authors.initials: JE
authors.lastname: Nam
authors.forename: Young Jin
authors.initials: YJ
authors.lastname: Kim
authors.forename: Hua Sun
authors.initials: HS
authors.lastname: Kim
authors.forename: Hee Yeong
authors.initials: HY
authors.lastname: Kim
authors.forename: Se Kyu
authors.initials: SK
authors.lastname: Kim
authors.forename: Joon
authors.initials: J
authors.lastname: Chang
authors.forename: Joo-Hang
authors.initials: JH
authors.lastname: Kim
authors.forename: Kyung Young
authors.initials: KY
authors.lastname: Chung
authors.forename: Byoung Wook
authors.initials: BW
authors.lastname: Choi
authors.forename: Kyu Ok
authors.initials: KO
authors.lastname: Choe
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000378:metabolism; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000951:Antigens, Neoplasm / Q000378:metabolism; D014408:Biomarkers, Tumor / Q000378:metabolism*; D044963:Biopsy, Fine-Needle; D002272:Carcinoembryonic Antigen / Q000378:metabolism; D018287:Carcinoma, Large Cell / Q000175:diagnosis / Q000378:metabolism; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000378:metabolism*; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000378:metabolism; D018797:Cell Cycle Proteins; D015331:Cohort Studies; D004268:DNA-Binding Proteins; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015592:Immunoradiometric Assay; D053539:Keratin-19 / Q000378:metabolism; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009687:Nuclear Proteins / Q000378:metabolism; D010750:Phosphoproteins / Q000378:metabolism; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D015843:Serpins / Q000378:metabolism; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
chemical_list: D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen; D018797:Cell Cycle Proteins; D004268:DNA-Binding Proteins; D053539:Keratin-19; D009687:Nuclear Proteins; D010750:Phosphoproteins; C429022:RAD21 protein, human; D015843:Serpins; C102012:antigen CYFRA21.1; C051072:squamous cell carcinoma-related antigen