title: Evaluation of predictive value of pleural CEA in patients with pleural effusions and histological findings: A prospective study and literature review.
abstract: OBJECTIVE
  Pleural effusion recognizes heterogeneous etiology and pathogenesis and requires invasive diagnostic procedures. Usually, after pleural fluid analysis, 30-50% of patients with malignant pleural effusion exhibit negative pleural cytology, and the sensitivity of image-guided pleural needle-aspiration biopsy ranges between 60% and 70%. With the aim of differentiating between benign (BPE) and malignant (MPE) pleural effusions, several tumor markers have been assayed in the pleural fluid and the majority of studies focus on pleural carcinoembryonic antigen (p-CEA). The aims of this study were to evaluate (i) the diagnostic accuracy of p-CEA of patients with pleural effusions undergoing video-assisted thoracoscopic surgery (VATS) for diagnostic purpose, (ii) the relationship between p-CEA and serum CEA (s-CEA), and (iii) the usefulness of the p-CEA/s-CEA ratio in the diagnosis of malignant pleural effusions (MPE).
  
  
  METHODS
  We prospectively enrolled in the study 134 consecutive patients with pleural effusions, scheduled for having VATS and biopsy. The final diagnosis, based on histopathology of the VATS-guided specimens, was available for all patients. p-CEA and s-CEA was assayed with a chemiluminescence immunoassay method (CLIA), applied on the Maglumi 2000 Plus automated platform (SNIBE, Shenzen, China).
  
  
  RESULTS
  The sensitivity and accuracy of p-CEA was significantly higher than that of pleural cytology at the same specificity comparing BPE with MPE and BPE with non-small lung cancer. The sensitivity of p-CEA and PC together reached 100% (BPE vs. NSCLC) and 91.5% (BPE vs. MPE excluding mesothelioma), respectively.
  
  
  CONCLUSIONS
  The p-CEA measurement in patients with pleural effusion of uncertain etiology is a safe and cost-effective procedure, everywhere easily available, which may help clinicians in selecting patients for further evaluations. An elevated p-CEA level in a patient with pleural effusion and negative pleural cytology suggests the need of more invasive procedure (e.g. VATS-guided biopsies), whilst low p-CEA may support a follow-up.
authors: Department of Laboratory Medicine, S. Maria degli Angeli Hospital, 33170 Pordenone, Italy. Electronic address: renato.tozzoli@aopn.sanita.fvg.it.
authors: Renato
authors: R
authors: Tozzoli
authors: Department of Surgery, Surgery 1, S. Maria degli Angeli Hospital, 33170 Pordenone, Italy.
authors: Stefano M M
authors: SM
authors: Basso
authors: Department of Laboratory Medicine, S. Maria degli Angeli Hospital, 33170 Pordenone, Italy.
authors: Federica
authors: F
authors: D'Aurizio
authors: Department of Laboratory Medicine, S. Maria degli Angeli Hospital, 33170 Pordenone, Italy.
authors: Paolo
authors: P
authors: Metus
authors: Department of Surgery, Oncology, and Gastroenterology, University of Padua, School of Medicine, 35128 Padova, Italy.
authors: Franco
authors: F
authors: Lumachi
mesh_terms: D015415:Biomarkers / Q000378:metabolism*; D002272:Carcinoembryonic Antigen / Q000378:metabolism*; D006801:Humans; D010994:Pleura / Q000276:immunology*; D010996:Pleural Effusion / Q000209:etiology / Q000276:immunology* / Q000473:pathology; D011237:Predictive Value of Tests
chemical_list: D015415:Biomarkers; D002272:Carcinoembryonic Antigen
keywords: Benign pleural effusions; Malignant pleural effusions; Pleural CEA; Pleural cytology; Serum CEA; VATS