title: Diagnostic value of soluble B7-H4 and carcinoembryonic antigen in distinguishing malignant from benign pleural effusion.
abstract: OBJECTIVE
  To explore the diagnostic value of joint detection of soluble B7-H4 (sB7-H4) and carcinoembryonic antigen (CEA) in identifying malignant pleural effusion (MPE) from benign pleural effusion (BPE).
  
  
  METHODS
  A total of 97 patients with pleural effusion specimens were enrolled from The First Affiliated Hospital of Zhengzhou University between June 2014 and December 2015. All cases were categorized into malignant pleural effusion group (n = 55) and benign pleural effusion group (n = 42) according to etiologies. Enzyme-linked immunosorbent assay was applied to examine the levels of sB7-H4 in pleural effusion and meanwhile CEA concentrations were detected by electro-chemiluminescence immunoassays. Receiver operating characteristic (ROC) curve was established to assess the diagnostic value of sB7-H4 and CEA in pleural effusion. The correlation between sB7-H4 and CEA levels was analyzed by Pearson's product-moment.
  
  
  RESULTS
  The concentrations of sB7-H4 and CEA in MPE exhibited obviously higher than those of BPE ([60.08 ± 35.04] vs. [27.26 ± 9.55] ng/ml, P = .000; [41.49 ± 37.16] vs. [2.41 ± 0.94] ng/ml, P = .000). The AUC area under ROC curve of sB7-H4 and CEA was 0.884 and 0.954, respectively. Two cutoff values by ROC curve analysis of sB7-H4 36.5 ng/ml and CEA 4.18 ng/ml were obtained, with a corresponding sensitivity (81.82%, 87.28%), specificity (90.48%, 95.24%), accuracy (85.57%, 90.72%), positive predictive value (PPV) (91.84%, 96.0%), negative predictive value (NPV) (79.17%, 85.11%), positive likelihood ratio (PLR) (8.614, 18.327), and negative likelihood ratio (NLR) (0.201, 0.134). When sB7-H4 and CEA were combined to detect pleural effusion, it obtained a higher sensitivity 90.91% and specificity 97.62%. Furthermore, correlation analysis result showed that the level of sB7-H4 was correlated with CEA level (r = .770, P = .000).
  
  
  CONCLUSIONS
  sB7-H4 was a potentially valuable tumor marker in the differentiation between BPE and MPE. The combined detection of sB7-H4 and CEA could improve the diagnostic sensitivity and specificity for MPE.
authors.affiliation: Department of Respiratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China.|Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China.
authors.forename: Xiaogang
authors.identifier: http://orcid.org/0000-0001-5699-4524
authors.initials: X
authors.lastname: Jing
authors.affiliation: Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China.
authors.forename: Fei
authors.initials: F
authors.lastname: Wei
authors.affiliation: Pingdingshan Industrial College of Technology, Institute of international communication, Pingdingshan, 467000, People's Republic of China.
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Respiratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China.|Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China.
authors.forename: Lingling
authors.initials: L
authors.lastname: Dai
authors.affiliation: Department of Respiratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China.|Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China.
authors.forename: Xi
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Respiratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China.|Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China.
authors.forename: Liuqun
authors.initials: L
authors.lastname: Jia
authors.affiliation: Department of Respiratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China.|Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China.
authors.forename: Huan
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Respiratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China.|Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China.
authors.forename: Lin
authors.initials: L
authors.lastname: An
authors.affiliation: Department of Respiratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China.|Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China.
authors.forename: Yuanjian
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Respiratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China.|Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China.
authors.forename: Guojun
authors.initials: G
authors.lastname: Zhang
authors.affiliation: Department of Respiratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China.|Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People's Republic of China.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Cheng
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism; D002272:Carcinoembryonic Antigen / Q000276:immunology / Q000378:metabolism*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010994:Pleura / Q000378:metabolism* / Q000473:pathology; D010996:Pleural Effusion / Q000378:metabolism* / Q000473:pathology; D016066:Pleural Effusion, Malignant / Q000378:metabolism* / Q000473:pathology; D011237:Predictive Value of Tests; D060907:V-Set Domain-Containing T-Cell Activation Inhibitor 1 / Q000378:metabolism*
chemical_list: D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen; D060907:V-Set Domain-Containing T-Cell Activation Inhibitor 1; C475826:VTCN1 protein, human
keywords: CEA; benign pleural effusion; malignant pleural effusion; sB7-H4