Background: Pleural effusion (PE) complicates the clinical course of several thoracic lesions, including lung cancer, pulmonary metastases, pleural mesothelioma, cardiac failure, pneumonia and tuberculosis. The pre-surgical diagnosis is difficult, and several imaging studies and biological tumor markers (TM) have been used in differentiating between benign and malignant PE. For this purpose, we retrospectively evaluated the usefulness of four serum and pleural potential risk factors for cancer in patients with PE. Methods: Data from a group of 163 patients with histologically confirmed benign (BPE, N=46, age 67.9±10.2 years) and malignant (MPE, N=117, age 68.5±13.5 years, p=0.769) PE were reviewed. Serum (sCEA) and pleural (pCEA) carcinoembryonic antigen, serum lactate dehydrogenase (LDH), and serum C-reactive protein (CRP) measurements were available in 94, 141, 153, and 94 patients, respectively. CEA was measured with automated method of immuno-chemiluminescence (LOCI, Dimension Vista, Siemens HD, Camberley, UK), while both LHD and CRP were measured by standard colorimetric assay kits. Results: Overall (MPE vs. BPE), sCEA, LDH, CRP, and pCEA values were 16.5±50.5 vs. 2.4±1.9 ng/mL (p=0.113), 260.8±243.6 vs. 242.7±228.2 IU/L (p=0.280), 4.4±4.7 vs. 5.6±5.8 mg/mL (p=0.280), and 135.7±620.3 vs. 1.49±1.24 ng/mL (p=0.218), respectively. The median value of each TM (sCEA=2.1 ng/mL, LDH=198 IU/L, CRP=2.7 mg/L, pCEA=12.8 ng/mL) was consider as cut-off value. The distribution of potential risk factors for malignancy in cases (MPE) and controls (BPE) are shown in the Table. Odds ratio (OR) estimates with associated 95% confidence interval (CI) and the relative p-value are also reported. Conclusions: Serum LDH (p=0.009) and pCEA (p=0.0006) represent the most sensitive TM for malignancy, when a noninvasive evaluation of BPE vs. MPE is required.
Diagnostic value of carcinoembryonic antigen, lactate dehydrogenase and C-reactive protein in patients with pleural effusion undergoing VATS thoracentesis
LUMACHI, FRANCO;
2016
Abstract
Background: Pleural effusion (PE) complicates the clinical course of several thoracic lesions, including lung cancer, pulmonary metastases, pleural mesothelioma, cardiac failure, pneumonia and tuberculosis. The pre-surgical diagnosis is difficult, and several imaging studies and biological tumor markers (TM) have been used in differentiating between benign and malignant PE. For this purpose, we retrospectively evaluated the usefulness of four serum and pleural potential risk factors for cancer in patients with PE. Methods: Data from a group of 163 patients with histologically confirmed benign (BPE, N=46, age 67.9±10.2 years) and malignant (MPE, N=117, age 68.5±13.5 years, p=0.769) PE were reviewed. Serum (sCEA) and pleural (pCEA) carcinoembryonic antigen, serum lactate dehydrogenase (LDH), and serum C-reactive protein (CRP) measurements were available in 94, 141, 153, and 94 patients, respectively. CEA was measured with automated method of immuno-chemiluminescence (LOCI, Dimension Vista, Siemens HD, Camberley, UK), while both LHD and CRP were measured by standard colorimetric assay kits. Results: Overall (MPE vs. BPE), sCEA, LDH, CRP, and pCEA values were 16.5±50.5 vs. 2.4±1.9 ng/mL (p=0.113), 260.8±243.6 vs. 242.7±228.2 IU/L (p=0.280), 4.4±4.7 vs. 5.6±5.8 mg/mL (p=0.280), and 135.7±620.3 vs. 1.49±1.24 ng/mL (p=0.218), respectively. The median value of each TM (sCEA=2.1 ng/mL, LDH=198 IU/L, CRP=2.7 mg/L, pCEA=12.8 ng/mL) was consider as cut-off value. The distribution of potential risk factors for malignancy in cases (MPE) and controls (BPE) are shown in the Table. Odds ratio (OR) estimates with associated 95% confidence interval (CI) and the relative p-value are also reported. Conclusions: Serum LDH (p=0.009) and pCEA (p=0.0006) represent the most sensitive TM for malignancy, when a noninvasive evaluation of BPE vs. MPE is required.
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