Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
권호 표지

Diagnostic Utility of Pleural Fluid CEA and CYFRA 21-1 for Malignant Pleural Effusions

악성 흉막액에서 CEA와 CYFRA 21-1의 진단적 유용성

  • Chung, Jae Ho (Department of Internal Medicine, Kwandong University College of Medicine, Myungji Hospital) ;
  • Choi, Jeong Eun (Department of Internal Medicine, Kwandong University College of Medicine, Myungji Hospital) ;
  • Park, Moo Suk (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Hwang, Sang Yon (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Moon, Jin Wook (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Kim, Young Sam (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Chang, Joon (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Kim, Joo Hang (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Kim, Sung Kyu (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Kim, Se Kyu (Department of Internal Medicine, Yonsei University College of Medicine)
  • 정재호 (관동대학교 의과대학 내과학교실) ;
  • 최정은 (관동대학교 의과대학 내과학교실) ;
  • 박무석 (연세대학교 의과대학 내과학교실) ;
  • 황상연 (연세대학교 의과대학 내과학교실) ;
  • 문진욱 (연세대학교 의과대학 내과학교실) ;
  • 김영삼 (연세대학교 의과대학 내과학교실) ;
  • 장준 (연세대학교 의과대학 내과학교실) ;
  • 김주항 (연세대학교 의과대학 내과학교실) ;
  • 김성규 (연세대학교 의과대학 내과학교실) ;
  • 김세규 (연세대학교 의과대학 내과학교실)
  • Received : 2003.12.22
  • Accepted : 2004.05.27
  • Published : 2004.07.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background : The purpose of this study was to evaluate the usefulness of the pleural fluid carcinoembryonic antigen (CEA) and cytokeratin fragment 19 (CYFRA 21-1) tumor markers as complementary tools for the diagnosis of malignant pleural effusions. Patients and Methods : The levels of pleural and serum CEA and CYFRA 21-1 were prospectively assayed in 222 patients with pleural effusions (150 benign effusions, 57 bronchogenic carcinomas and 15 metastatic carcinomas). Results : The levels of pleural fluid CEA and CYFRA 21-1 in the malignant effusions were significantly higher than those in the benign effusions. With a specificity of 95%, the cut off values for the CEA and CYFRA 21-1 in pleural effusions were 5 and 89 ng/ml, respectively. The diagnostic sensitivities of the pleural fluid CEA and CYFRA 21-1 in malignant effusions were 72 and 54%, respectively, whereas using a combination of the two, the sensitivity increased to 87% (p<0.05). Conclusions : These findings suggest that a combination of the pleural fluid CEA and CYFRA 21-1 in pleural effusions can be useful in the diagnosis of malignant pleural effusions.

목 적 : 악성 흉막액의 진단을 위해서는 흉막액 세포진 검사, 흉막 생검 등이 이용되지만 위음성의 문제가 있어서 이를 보완하기 위해서 지금까지 여러 종양 표지자들이 흉막액에서 측정되어 왔다. 저자 등은 흉막액의 감별진단에 널리 알려진 CEA와 최근에 소개된 CYFRA 21-1의 진단적 유용성에 대해 알아보기 위해 본 연구를 시행하였다. 방 법 : 2002년 4월부터 2003년 11월까지 흉막액으로 내원한 222예(양성 150예, 폐암 57예, 전이성암 15예)를 대상으로 하여 전향적으로 혈청과 흉막액에서 CEA와 CYFRA 21-1를 각각 측정하였다. 결 과 : 양성 흉막액에 비해 악성 흉막액에서 유의하게 CEA와 CYFRA 21-1값이 높았으며, 특이도를 95%로 하였을 때 흉막액 CEA와 CYFRA 21-1의 cut off 값은 각각 5, 89 ng/ml 이었고 민감도는 각각 72%, 54%이었다. 흉막액에서 CEA와 CYFRA 21-1를 병용하여 검사했을 때의 민감도는 87%로 CEA나 CYFRA 21-1 단독검사에 비해 유의하게 높게 나타났다(p<0.05). 결 론 : 흉막액 CEA와 CYFRA 21-1 검사의 병용은 악성흉막액의 진단에 유용할 것으로 생각된다.

Keywords

References

  1. Prakash UB, Reiman HM. Comparison of needle biopsy with cytologic analysis for the evaluation of pleural effusion: analysis of 414 cases. Mayo Clin Proc1985;60:158-64
  2. Stieber P, Hasholzner U, Bodenmuller H, Nagel D, Sunder-Plassmann L, Dienemann H, et al. CYFRA 21-1. A new marker in lung cancer. Cancer 1993;72:707-13
  3. McKenna JM, Chandrasekhar AJ, Henkin RE. Diagnostic value of carcinoembryonic antigen in exudative pleural effusions. Chest 1980;78:587-90
  4. Tamura S, Nishigaki T, Moriwaki Y, Fujioka H, Nakano T, Fujii J, et al. Tumor markers in pleural effusion diagnosis. Cancer 1988;61:298-302
  5. Garcia-Pachon E, Padilla-Navas I, Dosda MD, Miralles-Llopis A. Elevated level of carcinoembryonic antigen in nonmalignant pleural effusions. Chest 1997;111:643-7
  6. Rastel D, Ramaioli A, Cornillie F, Thirion B. CYFRA 21-1, a sensitive and specific new tumour marker for squamous cell lung cancer. Report of the firstEuropean multicentre evaluation. CYFRA 21-1 Multicentre Study Group. Eur J Cancer 1994;30A:601-6
  7. Muraki M, Tohda Y, Iwanaga T, Uejima H, Nagasaka Y, Nakajima S. Assessment of serum CYFRA 21-1 in lung cancer. Cancer 1996;77:1274-7
  8. Pujol JL, Grenier J, Daures JP, Daver A, Pujol H, Michel FB. Serum fragment of cytokeratin subunit 19 measured by CYFRA 21-1 immunoradiometric assayas a marker of lung cancer. Cancer Res 1993;53:61-6
  9. Toumbis M, Rasidakis A, Passalidou E, Kalomenidis J, Alchanatis M, Orphanidou D, et al. Evaluation of CYFRA 21-1 in malignant and benign pleuraleffusions. Anticancer Res 1996;16:2101-4
  10. Satoh H, Sumi M, Yagyu H, Ishikawa H, Suyama T, Naitoh T, et al. Clinical evaluation of CYFRA 21-1 in malignant pleural fluids. Oncology 1995;52:211-4
  11. Ferrer J, Villarino MA, Encabo G, Felip E, Bermejo B, Vila S, et al. Diagnostic utility of CYFRA 21-1, carcinoembryonic antigen, CA 125, neuron specificenolase, and squamous cell antigen level determinations in the serum and pleural fluid of patients with pleural effusions. Cancer 1999;86:1488-95
  12. Lee HJ, Lee KH, Shin KC, Shin CJ, Park HJ, Mun YC, et al. Diagnostic value of CYFRA 21-1 in differential diagnosis of pleural effusion. Tuberc RespirDis 1999;47:50-6
  13. Lee JH, Jang SH, Lee HL, Kwak SM, Chang HY, Kim BI, et al. Clinical significance of the combined assay of pleural fluid ADA activity and CEA level in the various pleural effusions. Tuberc and Respir Dis 1993;40:35-42
  14. Salama G, Miedouge M, Rouzaud P, Mauduyt MA, Pujazon MC, Vincent C, et al. Evaluation of pleural CYFRA 21-1 and carcinoembryonic antigen in thediagnosis of malignant pleural effusions. Br J Cancer 1998;77:472-6
  15. Paganuzzi M, Onetto M, Marroni P, Filiberti R, Tassara E, Parodi S, et al. Diagnostic value of CYFRA 21-1 tumor marker and CEA in pleural effusion dueto mesothelioma. Chest 2001;119:1138-42
  16. Romero S, Fernandez C, Arriero JM, Espasa A, Candela A, Martin C, et al. CEA, CA 15-3 and CYFRA 21-1 in serum and pleural fluid of patients with pleural effusions. Eur Respir J 1996;9:17-23
  17. Alatas F, Alatas O, Metintas M, Colak O, Harmanci E, Demir S. Diagnostic value of CEA, CA 15-3, CA 19-9, CYFRA 21-1, NSE and TSA assay in pleuraleffusions. Lung Cancer 2001;31:9-16