V. Villena et al., DIAGNOSTIC-VALUE OF CA-72-4, CARCINOEMBRYONIC ANTIGEN, GA-15-3, AND CA-19-9 ASSAY IN PLEURAL FLUID - A STUDY OF 207 PATIENTS, Cancer, 78(4), 1996, pp. 736-740
BACKGROUND. The differential diagnosis of pleural effusion is a freque
nt clinical problem. Several tumor markers have been evaluated in pleu
ral fluid, but the value of CA 72-4 assay and of combinations of tumor
marker assays has not been firmly established. To find a minimally in
vasive tool for differentiating between pleural effusions of malignant
or benign origin, the authors assessed the diagnostic value of CA 72-
4, carcinoembryonic antigen (CEA), CA 15-3, and CA 19-9 assays in pleu
ral fluid individually and in combination. METHODS. The authors prospe
ctively studied 207 patients with pleural effusion (65 malignant, 48 t
uberculous, 24 parapneumonic, 26 transudates, 14 miscellaneous; and 30
of unknown nonneoplastic origin). The levels of CA 72-4, CEA, CA 15-3
, and CA 19-9 were measured in pleural fluid by radioimmunoassay. RESU
LTS. CA 72-4 assay in pleural fluid had an acceptable sensitivity and
very good specificity for diagnosing malignant pleural effusion. The c
ombination of CA 72-4 plus CEA plus CA 15-3 yielded the best accuracy,
0.90 (95% confidence interval [CI] 0.85-0.94), with a sensitivity of
0.78 (95% CI, 0.67-0.88), specificity of 0.95 (95% CI, 0.90-0.98), pos
itive predictive value of 0.88 (95% CI, 0.77-0.95), and negative predi
ctive value of 0.91 (range, 0.85-0.94). A good clinical strategy may b
e to begin with a CEA assay (specificity of 1) and then, if it is nega
tive, to add CA 15-3 or even CA 72-4 assays to improve sensitivity. Th
e diagnosis of mesothelioma is more likely with a high CA 15-3 level a
nd normal CEA and CA 19-9 levels. CONCLUSIONS. Assays of CEA, CA 72-4,
and CA 15-3 in pleural fluid, or the combination of CEA with CA 15-3
and CA 72-4, was useful in differentiating between pleural effusion of
malignant and benign origin. (C) 1996 American Cancer Society.