title: Analysis of tumor markers in cytological fluid obtained from computed tomography-guided needle aspiration biopsies for the diagnosis of ground-glass opacity pulmonary lesions.
abstract: BACKGROUND
  The purpose of this study was to assess whether analyses of tumor markers in cytological fluid can improve the performance of computed tomography (CT)-guided needle aspiration biopsy (NAB) for the diagnosis of ground-glass opacity (GGO) pulmonary lesions.
  
  
  METHODS
  Forty-two patients were prospectively enrolled for CT-guided NAB. Levels of cytokeratin 19 fragments (CYFRA 21-1) and carcinoembryonic antigen (CEA) from serum and cytological fluid were measured. The cutoff values of 3.3 ng/mL for CYFRA 21-1 and 5.0 ng/mL for CEA (threshold A) or thresholds by adding 2 standard deviations to the mean levels of markers found in patients without malignancy (threshold B) were used to identify malignancy. The sensitivity and area under the curve (AUC) of NAB alone were compared with those of NAB combined with serum or cytological tumor markers.
  
  
  RESULTS
  Among the 42 patients, 30 (71.4%) had malignant and 12 (28.6%) had benign lesions. For NAB alone, the sensitivity, specificity, and AUC for diagnosing GGO were 70.0%, 100%, and 0.850, respectively. The sensitivity and AUC increased significantly for NAB with cytological CYFRA 21-1 compared with NAB alone, using both thresholds (threshold A: 86.7%, P=.026 and .933, P=.016; threshold B: 93.3%, P=.008 and .925, P=.046).
  
  
  CONCLUSIONS
  Cytological fluid measurements of CYFRA 21-1 can improve the diagnostic performance of CT-guided NAB for GGO pulmonary lesions.
authors.affiliation: Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Ga Ram
authors.initials: GR
authors.lastname: Kim
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: Yoo Jin
authors.initials: YJ
authors.lastname: Hong
authors.forename: Hyo Sup
authors.initials: HS
authors.lastname: Shim
authors.forename: Hee Yeong
authors.initials: HY
authors.lastname: Kim
authors.forename: Ji Won
authors.initials: JW
authors.lastname: Lee
authors.forename: Byoung Wook
authors.initials: BW
authors.lastname: Choi
mesh_terms: D000328:Adult; D000368:Aged; D000951:Antigens, Neoplasm / Q000378:metabolism*; D014408:Biomarkers, Tumor / Q000378:metabolism*; D001707:Biopsy, Needle; D002272:Carcinoembryonic Antigen / Q000378:metabolism; D003581:Cytodiagnosis; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy; D053539:Keratin-19 / Q000378:metabolism*; D008168:Lung / Q000378:metabolism / Q000473:pathology*; D008171:Lung Diseases / Q000175:diagnosis* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen; D053539:Keratin-19; C102012:antigen CYFRA21.1