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Das D, Basu S, Ray S, Koppayithodi S, Hazra B, Bandyopadhyay S, Saha A, Sen K. Generation of selenium nanoparticles under γ-Irradiation for optical sensing of Carcinoembryonic antigen. J Mol Liq 2022. [DOI: 10.1016/j.molliq.2022.119597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fan X, Liu Y, Liang Z, Wang S, Yang J, Wu A. Diagnostic Value of Six Tumor Markers for Malignant Pleural Effusion in 1,230 Patients: A Single-Center Retrospective Study. Pathol Oncol Res 2022; 28:1610280. [PMID: 35515016 PMCID: PMC9065255 DOI: 10.3389/pore.2022.1610280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/15/2022] [Indexed: 11/13/2022]
Abstract
Background: The diagnostic value of tumor markers in pleural effusion (PE) and serum for malignant pleural effusion (MPE) is still in debate. This study aimed to evaluate the diagnostic value of six tumor markers in PE, serum, and the corresponding PE/serum (PE/S) ratio in distinguishing MPE from benign pleural effusion (BPE). Methods: A total of 1,230 patients with PE (452 MPEs and 778 BPEs) were retrospectively included in the study. PE and serum levels of carcinoembryonic antigen (CEA), carbohydrate antigen 15-3 (CA15-3), carbohydrate antigen 125 (CA125), carbohydrate antigen 19-9 (CA19-9), cytokeratin 19 fragment (CYFRA 21-1), and neuron-specific enolase (NSE) were measured. The area under the curve (AUC) was used to assess the single and combined diagnostic values of the six tumor markers for MPE. Results: The levels of the six tumor markers in PE, serum, and PE/S were significantly higher in MPE than that in BPE, except for serum CA125. PE CEA showed the highest AUC [0.890 (0.871–0.907)] at a cut-off value of 3.7 ng/ml compared to any single tumor marker using receiver operating characteristic (ROC) analysis. The specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) of PE CEA were 74.1%, 95.5%, 90.5%, 86.4%, 16.47, and 0.27, respectively. The combination of PE CEA and serum CYFRA21-1 showed the best diagnostic performance with an AUC of 0.934 (sensitivity, 79.9%; specificity, 95.7%, PPV, 90.5; PLR, 17.35) among all two or three combinations. Besides, serum CYFRA21-1 was the best diagnostic tumor marker in distinguishing cytology-negative MPE from BPE at a cut-off value of 3.0 ng/ml. Conclusion: PE CEA was the best diagnostic tumor marker in distinguishing MPE from BPE. Serum CYFRA21-1 was the best diagnostic tumor marker in distinguishing cytology-negative MPE from BPE. The combination of PE CEA and serum CYFRA21-1 could increase the diagnostic performance in distinguishing MPE from BPE and cytology-negative MPE from BPE.
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Affiliation(s)
- Xin Fan
- Department of Dermatology, Ningbo First Hospital, Ningbo, China
| | - Yanqing Liu
- Department of Laboratory Medicine, Ningbo First Hospital, Ningbo, China
| | - Zhigang Liang
- Department of Thoracic Surgery, Ningbo First Hospital, Ningbo, China
| | - Shanshan Wang
- Department of Laboratory Medicine, Ningbo First Hospital, Ningbo, China
| | - Jing Yang
- Department of Respiratory and Critical Care, Ningbo First Hospital, Ningbo, China
| | - Aihua Wu
- Department of Laboratory Medicine, Ningbo First Hospital, Ningbo, China
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Raji H, Hamid Borsi S, Dargahi MalAmir M, Asadollah Salmanpour AR. Assessment of the diagnostic value of CEA, CA125, and CRP and their cut-off point for discrimination of exudative pleural effusions. BIONATURA 2021. [DOI: 10.21931/rb/2021.06.03.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Pleural effusion is divided into exudative and transudative effusion, and the distinction between exudate and transudate requires multiple investigations of biochemical parameters and their comparison in pleural fluid and serum. This study aimed to assess the diagnostic value of CEA, CA125, and CRP and their cut-off point for discrimination of exudative pleural effusions. This epidemiological and cross-sectional study was performed on 50 patients aged between 18 to 90 years with the diagnosis of exudative pleural effusion referred to Imam Khomeini Hospital in Ahvaz in 2018 and 2019. Demographic and clinical information of patients were collected. The pleural effusion was diagnosed based on physical examination and chest radiography. Pleural effusion was confirmed by thoracentesis. A pleural fluid sample was taken from all patients, and the levels of CEA, CA125, and CRP markers were measured in the pleural fluid. Differentiation of transudate and exudate pleural effusions was performed using Light criteria. The mean CEA and CA125 level of pleural fluid were significantly higher, and the mean CRP level of pleural fluid was significantly lower in patients with malignant diagnoses (P <0.05). Cut-off value with highest sensitivity and specificity in differentiating types of exudative pleural effusions was obtained for CEA tumor marker (greater than 49.8), CA125 tumor marker (greater than 814.02), and CRP marker (less than 7.56). Also, in differentiating types of exudative pleural effusions, CEA tumor marker had sensitivity (89.03%) and specificity (78.42%); CA125 tumor marker had sensitivity (53.18%) and specificity (62.44%), and CRP marker had sensitivity (82.16%), and specificity (89.05%) were. Although the tumor markers had high specificity in the present study, the low sensitivity of some of these tumor markers reduced their diagnostic value. On the other hand, given the numerous advantages of tumor markers, such as low cost and non-invasive, combining them with another can increase the diagnostic value and accuracy.
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Affiliation(s)
- Hanie Raji
- Air Pollution and Respiratory Diseases Research Center, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyed Hamid Borsi
- Air Pollution and Respiratory Diseases Research Center, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mehrdad Dargahi MalAmir
- Air Pollution and Respiratory Diseases Research Center, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ahmad Reza Asadollah Salmanpour
- Air Pollution, and Respiratory Diseases Research Center, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Krishnan VG, Kunoor A, Keechilath P, Mehta AA. Diagnostic utility of pleural fluid carcinoembryonic antigen in patients with exudative pleural effusion. Lung India 2021; 38:139-143. [PMID: 33687007 PMCID: PMC8098895 DOI: 10.4103/lungindia.lungindia_196_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Pleural effusion (PE) is presenting symptoms of many different diseases and is often a diagnostic challenge. Negative cytology in the malignant PE requires more complicated diagnostic procedures, such as closed pleural biopsy or thoracoscopic pleural biopsy. Not all the patients will be fit for such invasive procedures due to high risk. Tumor markers seem to be a promising alternative and have been proposed to aid in the differentiation of the PE etiology. Objective: The objective of the study was to evaluate the diagnostic value of pleural fluid carcinoembryonic antigen (CEA) in differentiation between malignant and nonmalignant PEs and to compare adenosine deaminase (ADA) levels with respect to malignant and nonmalignant PE. Methodology: It was a prospective observational study. Patients who presented with undiagnosed exudative PE during the time period 2016–2018 were studied. Pleural fluid was subjected to all routine investigations such as sugar, protein, lactate dehydrogenase, ADA, and CEA. Results: A total of 100 patients were included in the study. Fifty-one patients had malignancy. Univariate analysis showed that smoker, previous history of cancer, ADA <20, and CEA of >2.15 were variables associated with malignancy. Multivariate analysis showed pleural fluid CEA >2.15 as only independent risk factor associated with malignancy. The sensitivity of 91.5% and 65% and specificity of 92.5% and 81.4%, respectively, were found for CEA 2.15 ng/dl and ADA <16.5 U/L as plotted from receiver operating characteristic curve. The combined CEA and ADA (2.39 ng/ml and 16.5 U/L) values in pleural fluid had higher sensitivity of 100%. Conclusion: Our study demonstrated that pleural fluid CEA levels have a sensitivity of 93.5% and specificity of 73% in diagnosing of malignant PE. ADA levels lesser than 16.5 U/L were seen in patients with malignant PE, but less sensitive and specific compared to CEA. Combined ADA and CEA levels had higher sensitivity than CEA alone.
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Affiliation(s)
- Vishnu G Krishnan
- Department of Respiratory Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Akhilesh Kunoor
- Department of Respiratory Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Pavithran Keechilath
- Department of Medical Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Asmita Anilkumar Mehta
- Department of Respiratory Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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Zhang H, Li C, Hu F, Zhang X, Shen Y, Chen Y, Li F. Auxiliary diagnostic value of tumor biomarkers in pleural fluid for lung cancer-associated malignant pleural effusion. Respir Res 2020; 21:284. [PMID: 33121490 PMCID: PMC7596935 DOI: 10.1186/s12931-020-01557-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 10/22/2020] [Indexed: 12/11/2022] Open
Abstract
Background Pleural effusion (PE) can be divided into benign pleural effusion (BPE) and malignant pleural effusion (MPE). There is no consensus on the identification of lung cancer-associated MPE using the optimal cut-off levels from five common tumor biomarkers (CEA, CYFRA 21-1, CA125, SCC-Ag, and NSE). Therefore, we aimed to find indicators for the auxiliary diagnosis of lung cancer-associated MPE by analyzing and then validating the optimal threshold levels of these biomarkers in pleural fluid (PF) and serum, as well as the PF/serum ratio. Patients and method The study has two sets of patients, i.e. the training set and the test set. In the training set, 348 patients with PE, between January 1, 2016 and December 31, 2017, were divided into BPE and MPE based on the cytological diagnosis. Subsequently, the optimal cut-off levels of tumor biomarkers were analyzed. In the test set, the diagnostic compliance rate was verified with 271 patients with PE from January 1, 2018 to July 31, 2019 to evaluate the auxiliary diagnostic value of the aforementioned indicators. Result In the training set, PF CEA at the cut-off value of 5.23 ng/ml was the most effective indicator for MPE compared with other tumor biomarkers (all p < 0.001). In the test set, PF CEA at the cut-off value of 5.23 ng/ml showed the highest sensitivity, specificity and accuracy, positive and negative predictive value among other tumor biomarkers, which were 99.0%, 69.1%, 91.6%, 90.7%, and 95.9%, respectively. Conclusion PF CEA at the cut-off level of 5.23 ng/ml was the most effective indicator for identifying lung cancer-associated MPE among the five common tumor biomarkers.
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Affiliation(s)
- Hai Zhang
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, NO. 241, West Huaihai Road, Shanghai, 200030, China
| | - Changhui Li
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, NO. 241, West Huaihai Road, Shanghai, 200030, China
| | - Fang Hu
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, NO. 241, West Huaihai Road, Shanghai, 200030, China
| | - Xueyan Zhang
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, NO. 241, West Huaihai Road, Shanghai, 200030, China
| | - Yinchen Shen
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, NO. 241, West Huaihai Road, Shanghai, 200030, China
| | - Yuqing Chen
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, NO. 241, West Huaihai Road, Shanghai, 200030, China
| | - Feng Li
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, NO. 241, West Huaihai Road, Shanghai, 200030, China.
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Park JE, Do YW, Lee DH, Lee SY, Lim JK, Choi SH, Seo HW, Yoo SS, Lee SY, Cha SI, Park JY, Lee J, Kim CH. Idiopathic Pleural Effusions: Characteristics and Discrimination From Cytology-Negative Malignant Pleural Effusions. Am J Med Sci 2020; 360:236-242. [PMID: 32423747 DOI: 10.1016/j.amjms.2020.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/10/2020] [Accepted: 04/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The etiology of pleural effusions often remained unknown notwithstanding surgical pleural biopsy and further clinical observation. A better understanding of clinical characteristics of patients with idiopathic pleural effusion (IPE) may improve the ability to differentiate between IPEs and cytology-negative malignant pleural effusions (MPEs) and facilitate the identification of patients requiring invasive investigation. However, little is known about the clinical factors that can help distinguish patients with IPE from those with cytology-negative MPE. MATERIALS AND METHODS Patients who were diagnosed with IPE or cytology-negative MPE between 2010 and 2017 were enrolled in this retrospective study. Clinical, laboratory and radiologic characteristics were compared between patients with IPE and cytology-negative MPE. Diagnostic performances of predictors for IPE were assessed using receiver operating characteristic curves. RESULTS Of 146 patients undergoing pleural biopsy owing to cytology-negative pleural effusion of uncertain cause, MPE was confirmed in 54 patients. IPE was ultimately diagnosed in 22 patients. Multivariate analysis demonstrated that a minimal amount of pleural effusion (odds ratio [OR] = 12.41, P = 0.039), presence of pleural nodularity (OR = 0.01, P < 0.001) and pleural fluid carcinoembryonic antigen levels less than 14 ng/mL (OR = 87.59, P = 0.002) were independent factors for distinguishing IPEs from cytology-negative MPEs. A combination of the absence of pleural nodularity with pleural fluid carcinoembryonic antigen levels less than 14 ng/mL yielded an area under the curve of 0.94 (sensitivity = 91% and specificity = 96%). CONCLUSIONS Using these readily available parameters to identify IPE in patients with cytology-negative exudative effusion of unknown cause can help guide decision-making when choosing to perform an invasive pleural biopsy or to take a conservative approach.
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Affiliation(s)
- Ji Eun Park
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Young Woo Do
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Deok Heon Lee
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Sang Yub Lee
- Department of Radiology, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Jae Kwang Lim
- Department of Radiology, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Sun Ha Choi
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Hye Won Seo
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Seung Soo Yoo
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Shin Yup Lee
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Seung Ick Cha
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Jae Yong Park
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Jaehee Lee
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Republic of Korea.
| | - Chang Ho Kim
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Republic of Korea.
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Tian S, Cheng SB, Guo YY, Xie M, Zhan N, Zeng Z, Huang WH, Dong WG. High Efficient Isolation of Tumor Cells by a Three Dimensional Scaffold Chip for Diagnosis of Malignant Effusions. ACS APPLIED BIO MATERIALS 2020; 3:2177-2184. [PMID: 35025269 DOI: 10.1021/acsabm.0c00031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Shan Tian
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, Hubei 430060, China
| | - Shi-Bo Cheng
- College of Chemistry and Molecular Sciences, Wuhan University, Wuhan, Hubei 430072, China
| | - Ying-Yun Guo
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, Hubei 430060, China
| | - Min Xie
- College of Chemistry and Molecular Sciences, Wuhan University, Wuhan, Hubei 430072, China
| | - Na Zhan
- Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China
| | - Zhi Zeng
- Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China
| | - Wei-Hua Huang
- College of Chemistry and Molecular Sciences, Wuhan University, Wuhan, Hubei 430072, China
| | - Wei-Guo Dong
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, Hubei 430060, China
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Chen Z, Wang Y, Fang M. Analysis of tumor markers in pleural effusion and serum to verify the correlations between serum tumor markers and tumor size, TNM stage of lung adenocarcinoma. Cancer Med 2020; 9:1392-1399. [PMID: 31881123 PMCID: PMC7013070 DOI: 10.1002/cam4.2809] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 12/09/2019] [Accepted: 12/13/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The study of tumor markers (TM) in pleural effusion (PE) was not extensive. METHODS TM in PE and serum were analyzed to determine whether TM was expressed in intrathoracic and extrathoracic tissues. To further verify the correlations between serum TM and tumor size, TNM stage of lung adenocarcinoma. RESULTS Serum AFP was not correlated with tumor size, T stage, N stage, and M stage (P > .05). Serum CEA, serum CA125, serum CA15-3 were positively correlated with tumor size, T stage, N stage, M stage (P < .05). Serum CA19-9 was not significantly correlated with tumor size and T stage (P > .05), but was positively correlated with N stage and M stage (P < .05). The levels of PE CEA, PE CA125, PE CA15-3 were higher than those of serum CEA, serum CA125, serum CA15-3 (all P < .05). The level of PE AFP was lower than that of serum AFP (P < .05). The level of PE CA19-9 was not significantly different from that of serum CA19-9 (P > .05). The positive rates of PE CEA and PE CA125 were higher than those of serum CEA and serum CA125 (P < .05). The positive rates of PE AFP, PE CA15-3, PE CA19-9 were not significantly different from those of serum AFP, serum CA15-3, serum CA19-9 (P > .05).PE CEA, PE CA125, PE CA15-3 were moderately positively correlated with serum CEA, serum CA125, serum CA15-3, respectively (r = 0.597; r = 0.46; r = 0.583, all P < .05). However, PE AFP and PE CA19-9 were very strongly positively correlated with serum AFP and serum CA19-9, respectively (r = 0.888; r = 0.874, all P < .05). CONCLUSION The expression characteristics of TM in PE and serum supported the correlations between serum TM and tumor size, TNM stage of lung adenocarcinoma.
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Affiliation(s)
- Zhongqing Chen
- Department of Clinical LaboratoryGuangxi Medical University Cancer HospitalNanningGuangxiPeople’s Republic of China
| | - Ying Wang
- Department of Clinical LaboratoryGuangxi Medical University Cancer HospitalNanningGuangxiPeople’s Republic of China
| | - Min Fang
- Department of Clinical LaboratoryGuangxi Medical University Cancer HospitalNanningGuangxiPeople’s Republic of China
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Chen Z, Miao H, Zeng Q, Xu S, Chen Z, Liu K. Circulating cell-free DNA as a diagnostic and prognostic biomarker for non-small-cell lung cancer: a systematic review and meta-analysis. Biomark Med 2019; 14:587-597. [PMID: 31845833 DOI: 10.2217/bmm-2018-0093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Aim: A meta-analysis was conducted to assess the application of circulating cell-free DNA (cfDNA) in non-small-cell lung carcinoma (NSCLC) screening, EGFR and KRAS mutation detection. Materials & methods: A comprehensive literature search was conducted. The summary sensitivity and specificity for cfDNA in NSCLC diagnosis, EGFR and KRAS mutation detection were calculated. Results: The sensitivity and specificity for NSCLC diagnosis, EGFR and KRAS mutation detection were 0.80 (95% CI: 0.72-0.87) and 0.81 (95% CI: 0.68-0.91), 0.780 (95% CI: 0.711-0.853) and 0.962 (95% CI: 0.942-0.984), 0.628 (95% CI: 0.244-0.919) and 0.959 (95% CI: 0.932-0.998), respectively. Conclusion: cfDNA was a minimally invasive approach for NSCLC diagnosis, but its clinical utility warranted more future investigations because of the suboptimal sensitivity.
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Affiliation(s)
- Zhoumiao Chen
- Department of Thoracic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 Qinchun Road, Hangzhou, Zhejiang 310016, China
| | - Huiwen Miao
- Department of Thoracic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 Qinchun Road, Hangzhou, Zhejiang 310016, China
| | - Qingxin Zeng
- Department of Thoracic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 Qinchun Road, Hangzhou, Zhejiang 310016, China
| | - Shaohua Xu
- Department of Thoracic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 Qinchun Road, Hangzhou, Zhejiang 310016, China
| | - Zhao Chen
- Department of Thoracic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 Qinchun Road, Hangzhou, Zhejiang 310016, China
| | - Kai Liu
- Department of Thoracic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 Qinchun Road, Hangzhou, Zhejiang 310016, China
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Milevoj Kopcinovic L, Culej J, Jokic A, Bozovic M, Kocijan I. Laboratory testing of extravascular body fluids: National recommendations on behalf of the Croatian Society of Medical Biochemistry and Laboratory Medicine. Part I - Serous fluids. Biochem Med (Zagreb) 2019; 30:010502. [PMID: 31839720 PMCID: PMC6904973 DOI: 10.11613/bm.2020.010502] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 05/20/2019] [Indexed: 12/16/2022] Open
Abstract
Extravascular body fluids (EBF) analysis can provide useful information in the differential diagnosis of conditions that caused their accumulation. Their unique nature and particular requirements accompanying EBF analysis need to be recognized in order to minimize possible negative implications on patient safety. This recommendation was prepared by the members of the Working group for extravascular body fluid samples (WG EBFS). It is designed to address the total testing process and clinical significance of tests used in EBF analysis. The recommendation begins with a chapter addressing validation of methods used in EBF analysis, and continues with specific recommendations for serous fluids analysis. It is organized in sections referring to the preanalytical, analytical and postanalytical phase with specific recommendations presented in boxes. Its main goal is to assist in the attainment of national harmonization of serous fluid analysis and ultimately improve patient safety and healthcare outcomes. This recommendation is intended to all laboratory professionals performing EBF analysis and healthcare professionals involved in EBF collection and processing. Cytological and microbiological evaluations of EBF are beyond the scope of this document.
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Affiliation(s)
- Lara Milevoj Kopcinovic
- Croatian Society of Medical Biochemistry and Laboratory Medicine, Working group for extravascular body fluid samples.,Department of Clinical Chemistry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Jelena Culej
- Croatian Society of Medical Biochemistry and Laboratory Medicine, Working group for extravascular body fluid samples.,Department of Clinical Chemistry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Anja Jokic
- Croatian Society of Medical Biochemistry and Laboratory Medicine, Working group for extravascular body fluid samples.,Department of Medical Biochemistry, Haematology and Coagulation with Cytology, University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Zagreb, Croatia
| | - Marija Bozovic
- Croatian Society of Medical Biochemistry and Laboratory Medicine, Working group for extravascular body fluid samples.,Department of Clinical Chemistry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Irena Kocijan
- Croatian Society of Medical Biochemistry and Laboratory Medicine, Working group for extravascular body fluid samples.,Medical Biochemistry Laboratory, General hospital Varaždin, Varaždin, Croatia
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Yao Y, Yan C, Zhang W, Wu SG, Guan J, Zeng G, Du Q, Huang C, Zhang H, Wang H, Hou Y, Li Z, Wang L, Zheng Y, Li X. Development and validation of a novel diagnostic model for assessing lung cancer metastasis in a Chinese population based on multicenter real-world data. Cancer Manag Res 2019; 11:9213-9223. [PMID: 31807063 PMCID: PMC6827356 DOI: 10.2147/cmar.s217970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 08/23/2019] [Indexed: 12/19/2022] Open
Abstract
Background Accurate disease staging plays an important role in lung cancer's clinical management. However, due to the limitation of the CT scan, it is still an unmet medical need in practice. In the present study, we attempted to develop diagnostic models based on biomarkers and clinical parameters for assessing lung cancer metastasis. Methods This study consisted of 799 patients with pulmonary lesions from three regional centers in China. It included 274 benign lesions patients, 326 primary lung cancer patients without metastasis, and 199 advanced lung cancer patients with lymph node or organ metastasis. The patients were divided into nodules group and masses group according to tumor size. Results Four nomogram models based on patient characteristics and tumor biomarkers were developed and evaluated for patients with nodules and masses, respectively. In patients with pulmonary nodules, the AUC to identify metastatic lung cancer from unidentified nodules (including benign nodules and lung cancer, model 1) reached 0.859 (0.827–0.887, 95% CI). Model 2 was used to predict metastasis in patients with lung cancer with AUC of 0.838 (0.795–0.876, 95% CI). In patients with pulmonary masses, the AUC to identify metastatic lung cancer from unidentified masses (model 3) reached 0.773 (0.717–0.823, 95% CI). Model 4 was used to predict metastasis in patients with lung cancer and AUC reached 0.731 (0.771–0.793, 95% CI). Decision curve analysis corroborated good clinical applicability of the nomograms in predicting metastasis. Conclusion All new models demonstrated promising discrimination, allowing for estimating the risk of lymph node or organ metastasis of lung cancer. Such integration of blood biomarker testing with CT imaging results will be an efficient and effective approach to benefit the accurate staging and treatment of lung cancer.
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Affiliation(s)
- Yiyong Yao
- Department of Respiratory Medicine, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, People's Republic of China
| | - Cunling Yan
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, People's Republic of China
| | - Wei Zhang
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, People's Republic of China
| | - San-Gang Wu
- Department of Radiation Oncology, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
| | - Jie Guan
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, People's Republic of China
| | - Gang Zeng
- Department of Respiratory Medicine, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, People's Republic of China
| | - Qiang Du
- Department of Respiratory Medicine, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, People's Republic of China
| | - Chun Huang
- Department of Respiratory Medicine, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, People's Republic of China
| | - Hui Zhang
- Department of Laboratory, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, People's Republic of China
| | - Huiling Wang
- Department of Respiratory Medicine, The Second Affiliated Hospital, Dalian Medical University, Dalian, People's Republic of China
| | - Yanfeng Hou
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, People's Republic of China
| | - Zhiyan Li
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, People's Republic of China
| | - Lixin Wang
- Department of TCM and Western Medicine, Shanghai Pulmonary Hospital Affiliated to Tongji University, Shanghai, People's Republic of China
| | - Yijie Zheng
- Medical Scientific Affairs, Abbott Diagnostics Division, Abbott Laboratories, Asian Pacific Group, Shanghai, People's Republic of China
| | - Xun Li
- Department of Laboratory Medicine, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, People's Republic of China
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12
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Laboratory Discrimination Between Neutrophilic Malignant and Parapneumonic Pleural Effusions. Am J Med Sci 2019; 358:115-120. [PMID: 31331448 DOI: 10.1016/j.amjms.2019.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 03/29/2019] [Accepted: 04/09/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Malignant pleural effusion (MPE) occasionally demonstrates neutrophilic predominance, commonly found in parapneumonic pleural effusion (PPE). In comparison with lymphocytic MPE, neutrophilic MPE may have different characteristics associated with a more intense inflammatory response and poor prognosis. These characteristics of neutrophilic MPE may lead to inappropriate management and delayed diagnosis. Moreover, the limited diagnostic yield of microbiologic and cytologic tests makes early differential diagnosis between neutrophilic MPE and PPE more challenging. This study investigated objective laboratory findings to help distinguish neutrophilic MPE from PPE. MATERIALS AND METHODS A retrospective study was conducted on patients with neutrophilic MPE and PPE. Routine blood and pleural fluid data of the 2 groups were compared, and the diagnostic performances of predictors for neutrophilic MPE were assessed using receiver-operating characteristic curves. RESULTS Forty-one and 140 patients with neutrophilic MPE and PPE, respectively, were included. In final analysis, serum C-reactive protein, pleural fluid neutrophil-to-lymphocyte ratio, and pleural fluid carcinoembryonic antigen were significantly different between the 2 groups. With cut-off values of C-reactive protein <6.0 mg/dL, neutrophil-to-lymphocyte ratio <3.0 and carcinoembryonic antigen >8.0 ng/mL, the presence of any 2 or more parameters provided an area under the curve of 0.928 (95% CI, 0.851-0.999), yielding a sensitivity of 88%, specificity of 98%, positive predictive value of 92% and negative predictive value of 96% for identifying MPE. CONCLUSIONS MPE should be considered even in patients with neutrophilic exudative effusion, especially if at least 1 predictor for neutrophilic MPE is present. Our results may help guide differentiation of neutrophilic MPE from PPE.
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Farahani SJ, Baloch Z. Are we ready to develop a tiered scheme for the effusion cytology? A comprehensive review and analysis of the literature. Diagn Cytopathol 2019; 47:1145-1159. [PMID: 31301215 DOI: 10.1002/dc.24278] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 07/01/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cytology is widely utilized in the initial evaluation of fluid accumulation in the body cavities. The aim of this study was to determine the accuracy of cytology in distinguishing between benign and malignant (MAL) effusions. METHODS A comprehensive and systematic review of the literature was conducted to evaluate the accuracy of serous effusion cytology (SEC) against tissue biopsy/resection histology, imaging, or clinical follow-up as the reference test. Risk of publication bias and level of heterogeneity in the included studies was assessed. Meta-regression was performed to assess the effect of various variables on the accuracy of SEC. RESULTS Eighty studies met the inclusion criteria for meta-analysis comprising of 34 941 samples; of which 52 (0.2%), 22 202 (72.7%), 194 (0.6%), 711 (2.3%), and 6507 (21.3%) could be reclassified as nondiagnostic (ND), negative for malignancy (NFM), atypical (atypia of uncertain significance-AUS), suspicious for malignancy (SFM), and malignant (MAL), respectively. On follow-up, the mean risk of malignancy for ND, NFM, AUS, SFM, MAL was 17.4%, 20.7%, 65.9%, 81.8%, and 98.9%, respectively. A total of 73 studies were included in estimating the diagnostic accuracy of SEC. The bivariate mixed-effect model estimated the SEC sensitivity, specificity, diagnostic odds ratio, positive likelihood ratio, and negative likelihood ratio as 73.1%, 99.9%, 7850.6%, 2112.2%, and 0.27%, respectively. CONCLUSION Serous effusion cytology shows high specificity and moderate sensitivity in the evaluation of serous effusions. A tiered classification scheme can improve the consistency of terminology for reporting SEC results, thus improving communication between the pathologists and clinical team, and quality of patient care.
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Affiliation(s)
- Sahar J Farahani
- Department of Pathology & Laboratory Medicine, University of Pennsylvania Medical Center, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Zubair Baloch
- Department of Pathology & Laboratory Medicine, University of Pennsylvania Medical Center, Perelman School of Medicine, Philadelphia, Pennsylvania
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14
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Hackner K, Errhalt P, Handzhiev S. Ratio of carcinoembryonic antigen in pleural fluid and serum for the diagnosis of malignant pleural effusion. Ther Adv Med Oncol 2019; 11:1758835919850341. [PMID: 31205509 PMCID: PMC6535745 DOI: 10.1177/1758835919850341] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 04/05/2019] [Indexed: 11/15/2022] Open
Abstract
Background Tumour markers in pleural fluid and their diagnostic value are subject to debate. Although there are several studies on this topic, standardized cut-off values do not exist. In this study we investigated the potential of a ratio of carcinoembryonic antigen (CEA) in pleural fluid and serum, serving as an individual marker for pleural cancer manifestation. Methods A total of 201 consecutive patients with unclear pleural effusion were included in the study; 98 were diagnosed with malignant pleural effusion and 103 had an effusion due to other, benign reasons. CEA levels in pleural fluid and serum were measured. Results By using receiver operating characteristics analysis, at the cut-off of 1.0, the CEA ratio showed a specificity of 92% and sensitivity of 85%, with a positive predictive value of 91% and a negative predictive value of 87%. These results are higher than in previous investigations on different pleural tumour markers and their combination. Conclusions The CEA ratio is a useful tool in predicting pleural carcinosis. Elevated results in cytology-negative patients should lead to further investigations, such as repeated cytological examination or thoracoscopy.
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Affiliation(s)
| | - Peter Errhalt
- Department of Pneumology, University Hospital Krems, Austria, and Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Sabin Handzhiev
- Department of Pneumology, University Hospital Krems, Austria, and Karl Landsteiner University of Health Sciences, Krems, Austria
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15
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Chen Z, Li P, Zhang Z, Zhai X, Liang J, Chen Q, Li K, Lin G, Liu T, Wu Y. Ultrasensitive Sensor Using Quantum Dots-Doped Polystyrene Nanospheres for Clinical Diagnostics of Low-Volume Serum Samples. Anal Chem 2019; 91:5777-5785. [DOI: 10.1021/acs.analchem.9b00010] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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16
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Enz N, Fragoso F, Gamrekeli A, Lippek F, Jungraithmayr W. Carcinoembryonic antigen-positive pleural effusion in early stage non-small cell lung cancer without pleural infiltration. J Thorac Dis 2018; 10:E340-E343. [PMID: 29997989 DOI: 10.21037/jtd.2018.04.111] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Carcinoembryonic antigen (CEA) is a tumor marker for detecting recurrences of adenocarcinomas such as colon cancer. In lung adenocarcinoma, CEA elevation can be found in both serum and malignant pleural effusion. However, CEA elevation in cytologically negative pleural effusion in the presence of adenocarcinoma without pleural infiltration has not been described. We here present the case of an 82-year-old man with incidental early stage adenocarcinoma of the right upper lobe showing CEA elevation in pleural fluid and serum despite negative cytological findings. Due to limited lung reserve the tumor was removed by wide wedge resection, but the visceral pleura was not affected and infiltration of the parietal pleura was ruled out by pleural biopsies. Serum and pleural CEA levels declined postoperatively as measured at 1 and 2 months follow-up. This case shows CEA elevation in serum and pleural fluid in early stage lung adenocarcinoma with negative cytology and no sign of pleural infiltration. Previous research revealed that CEA level in pleural effusion correlates to serum CEA and is significantly higher in adenocarcinoma of the lung than in other lung cancer entities. Firstly, this case suggests that determination of CEA levels can increase the diagnostic sensitivity in cases with cytologically negative pleural effusion suspicious of malignant origin and secondly, it contributes valuable information to the decision whether follow-up of pulmonary nodules or continuative diagnostics such as video-assisted thoracoscopic surgery (VATS) wedge resection is indicated.
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Affiliation(s)
- Njanja Enz
- Department of Thoracic Surgery, Brandenburg Medical School, Neuruppin, Germany
| | - Fernando Fragoso
- Department of Thoracic Surgery, Brandenburg Medical School, Neuruppin, Germany
| | - Alexander Gamrekeli
- Department of Thoracic Surgery, Brandenburg Medical School, Neuruppin, Germany
| | - Frank Lippek
- Department of Pathology, Brandenburg Medical School, Neuruppin, Germany
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Ni X, Wu P, Wu J, Ji M, Tian B, Jiang Z, Sun Y, Xing X, Jiang J, Wu C. Hyperthermic intraperitoneal perfusion chemotherapy and response evaluation in patients with gastric cancer and malignant ascites. Oncol Lett 2017; 14:1691-1696. [PMID: 28789396 DOI: 10.3892/ol.2017.6342] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 03/03/2017] [Indexed: 12/11/2022] Open
Abstract
The present study describes the use of bidirectional chemotherapy in the treatment of patients with gastric cancer and peritoneal carcinomatosis (PC), using newly developed response criteria for the treatment of malignant ascites. In addition, the association between effusion response and survival was analyzed. Between June 2010 and May 2014, patients affected by malignant ascites secondary to unresectable PC of gastric origin were treated with a combination of systemic and loco-regional chemotherapy. Cisplatin (75 mg/m2) at an inflow temperature of 43°C was infused intraperitoneally, and docetaxel (75 mg/m2) was infused simultaneously via a peripheral vein, on day 1 every 3 weeks. The primary endpoint was overall survival rate, and the secondary endpoint was efficacy against malignant ascites using new response criteria. In total, 41 patients were enrolled, the majority of whom received 6 cycles of intraperitoneal chemotherapy in combination with hyperthermia. The majority of patients exhibited clinical regression of ascites and relief of associated symptoms. Malignant ascites disappeared [complete response (CR)] or decreased by 50% [partial response (PR)] in 73.2% of patients. No mortalities associated with the procedures occurred. The median survival time was 8.6 months, and the 1-year survival rate was 24.4%. As these new response criteria for the treatment of malignant ascites were found to be feasible, bidirectional chemotherapy may be the preferred strategy for the treatment of gastric cancer with PC. The CR, PR and non-PR groups showed significant differences in overall survival, indicating that decreased effusion was associated with improved patient survival.
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Affiliation(s)
- Xuefeng Ni
- Department of Oncology, The Third Affiliated Hospital, Soochow University, Changzhou, Jiangsu 213003, P.R. China
| | - Ping Wu
- Department of Pharmacology, The Third Affiliated Hospital, Soochow University, Changzhou, Jiangsu 213003, P.R. China
| | - Jun Wu
- Department of Oncology, The Third Affiliated Hospital, Soochow University, Changzhou, Jiangsu 213003, P.R. China
| | - Mei Ji
- Department of Oncology, The Third Affiliated Hospital, Soochow University, Changzhou, Jiangsu 213003, P.R. China
| | - Bo Tian
- Department of Pathology, The Third Affiliated Hospital, Soochow University, Changzhou, Jiangsu 213003, P.R. China
| | - Zhenxing Jiang
- Department of Radiology, The Third Affiliated Hospital, Soochow University, Changzhou, Jiangsu 213003, P.R. China
| | - Yue Sun
- Department of Ultrasonography, The Third Affiliated Hospital, Soochow University, Changzhou, Jiangsu 213003, P.R. China
| | - Xiaoxiao Xing
- Department of Ultrasonography, The Third Affiliated Hospital, Soochow University, Changzhou, Jiangsu 213003, P.R. China
| | - Jingting Jiang
- Department of Oncology, The Third Affiliated Hospital, Soochow University, Changzhou, Jiangsu 213003, P.R. China
| | - Changping Wu
- Department of Oncology, The Third Affiliated Hospital, Soochow University, Changzhou, Jiangsu 213003, P.R. China
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