Evaluation of seven tumour markers in pleural fluid for the diagnosis of malignant effusions

Carcinoembryonic antigen (CEA), carbohydrate antigens 15-3, 19-9 and 72-4 ( CA 15-3, CA 19-9 and CA 72-4), cytokeratin 19 fragments (CYFRA 21-1), neuro n-specific enolase (NSE) and squamous cell carcinoma antigen (SCC) were eva luated in pleural fluid for the diagnosis of malignant effusions. With a sp ecificity of 99%, determined in a series of 121 benign effusions, the best individual diagnostic sensitivities in the whole series of 215 malignant ef fusions or in the subgroup of adenocarcinomas were observed with CEA, GA 15 -3 and CA 72-4. As expected, a high sensitivity was obtained with SCC in sq uamous cell carcinomas and with NSE in small-cell lung carcinomas. CYFRA an d/or CA 15-3 were frequently increased in mesotheliomas. Discriminant analy sis showed that the optimal combination for diagnosis of nonlymphomatous ma lignant effusions was CEA + CA 15-3 + CYFRA + NSE: sensitivity of 94.4% wit h an overall specificity of 95%. in malignant effusions with a negative cyt ology, 83.9% were diagnosed using this association. The association CYFRA NSE + SCC was able to discriminate adenocarcinomas from small-cell lung ca ncers. Regarding their sensitivity and their complementarity, CEA, CA 15-3, CYFRA 21-1, NSE and SCC appear to be very useful to improve the diagnosis of malignant pleural effusions. (C) 1999 Cancer Research Campaign.