Proteins that are expressed by both malignant and healthy fetal tissues are recognized as oncofetal. These antigens are associated with cell proliferation and differentiation and are produced in high concentrations in pregnancy and malignancy. Their biological role in malignancy is the suppression of the host's immune system, while in pregnancy they affect the maternal immune response, generating maternal tolerance toward the embryo. This review describes the levels of alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), carcinoembryonic antigen (CEA), cancer antigen 125 (CA 125), squamous cell carcinoma antigen (SCC), cancer antigen 15-3 (CA 15-3), mucin-like carcinoma-associated antigen (MCA), tissue polypeptide-specific antigen (TPS), carbohydrate antigen 19-9 (CA 19-9), and prostate-specific antigen (PSA) in maternal serum (MS), umbilical cord serum (UC), and amniotic fluid (AF) and outlines their roles in the assessment of pregnancy and malignancy. All antigens studied, except CA 15-3, are on...

Tumor markers in biological fluids associated with pregnancy.

Background and objective:  Conventional tests are not always helpful in making a diagnosis of malignant pleural effusion (MPE). Many studies have investigated the utility of pleural carcinoembryonic antigen (CEA) in the early diagnosis of MPE. The present meta-analysis determined the accuracy of CEA measurement in the diagnosis of MPE.



Methods:  A systematic review of English language studies was conducted and data on the accuracy of pleural CEA concentrations in the diagnosis of MPE were pooled using random effects models. Receiver operating characteristic curves were used to summarize the overall test performance.



Results:  Forty-five studies met the inclusion criteria for the meta-analysis. The summary estimates for CEA in the diagnosis of MPE were: sensitivity 0.54 (95% CI: 0.52–0.55), specificity 0.94 (95% CI: 0.93–0.95), positive likelihood ratio 9.52 (95% CI: 6.97–13.01), negative likelihood ratio 0.49 (95% CI: 0.44–0.54) and diagnostic odds ratio 22.5 (95% CI: 15.6–32.5). Analysis of a subset of 11 studies which examined the value of pleural CEA in ruling out a diagnosis of malignant mesothelioma found that the sensitivity and specificity of a CEA level exceeding cut-off values were 0.97 (95% CI: 0.93–0.99) and 0.60 (95% CI: 0.55–0.65), respectively.



Conclusions:  Measurement of pleural CEA is likely to be a useful diagnostic tool for confirming MPE, and is also helpful in the differential diagnosis between malignant pleural mesothelioma and metastatic lung cancer. The results of CEA assays should be interpreted in parallel with clinical findings and the results of conventional tests.

Diagnostic value of carcinoembryonic antigen in malignant pleural effusion: a meta-analysis.

In order to evaluate the diagnostic yield of tumor markers in differentiating malignant and benign pleural effusions, we carried out a prospective study in a group of Iranian people. Pleural and serum levels of carcinoembryonic antigen (CEA), carbohydrate antigen 15-3 (CA 15-3), neuron-specific enolase (NSE) and cancer antigen 125 (CA 125) were assayed prospectively in patients with pleural effusion (40 malignant and 37 benign). The highest sensitivity was obtained with a combination of CA 15-3 in serum, and CA 15-3 and CEA in pleural fluid (80%), also with combination of CA 15-3 in serum, and CA 15-3, NSE and CEA in pleural fluid (80%). The highest specificity was obtained with combination of CA 15-3 in serum, and CA 15-3 and NSE in pleural fluid (100%), and also with combination of CA 15-3 in serum, and CA 15-3, NSE and CEA in pleural fluid (100%). (Pathology Oncology Research Vol 11, No 4, 236–241)

Diagnostic value of tumor markers for differentiating malignant and benign pleural effusions of Iranian patients.

Performance of CEA and CA19-9 in identifying pleural effusions caused by specific malignancies.

A positive cytology result in pericardial fluid is the gold standard for recognition of malignant pericardial effusion. Unfortunately, in 30-50% of patients with malignant pericardial effusion cytological examination of the pericardial fluid is negative. Tumor marker assessment in pericardial fluid may help to recognize malignant pericardial effusion. The aim of our study was to estimate the value of CYFRA 21-1 and CEA measurement in pericardial fluid for the recognition of malignant pericardial effusion. To our knowledge this is the first study on CYFRA 21-1 assessment in pericardial effusion. The examined group consisted of 50 patients with malignant pericardial effusion and 34 patients with non-malignant pericardial effusion. Median CEA concentrations in malignant pericardial effusion and non-malignant pericardial effusion were 80 ng/mL (0-317) and 0.5 ng/mL (0-18.4), respectively (p 100 ng/mL or CEA >5 ng/mL were found in 14/15 patients with malignant pericardial effusion and negative pericardial fluid cytology. We therefore strongly recommend the use of CYFRA 21-1 and/or CEA in addition to pericardial fluid cytology for the recognition of malignant pericardial effusion. (Int J Biol Markers 2005; 20: 43-49).

Diagnostic utility of CYFRA 21-1 and CEA assays in pericardial fluid for the recognition of neoplastic pericarditis.

Objective: The aim of this study was to evaluate the false positive rate for pleural fluid carcinoembryonic antigen (CEA) level in non-malignant pleural effusions and to determine whether the falsely elevated CEA level has any relation to other biochemical parameters of pleural effusions.



Methodology:  We performed a retrospective analysis of 654 consecutive patients with a pleural effusion admitted to the pulmonary department of a tertiary referral teaching hospital from March 1997 to March 1999. The aetiology of the pleural effusions were classified as tuberculosis (n = 262), malignancy (n = 204), pneumonia (n = 145), exudates of other origin (n = 28) and transudate (n = 1).



Results:  A false positive result for pleural fluid CEA level (> 5 ng/mL) was registered in 13.8% of non-malignant pleural effusion cases: empyema (38.6%), parapneumonic effusion (14.7%), exudates of other origin (14.3%), tuberculosis (7.3%) and transudate (6.7%). In analysis of the subgroup with false positive results for pleural fluid CEA level, the CEA level of non-malignant pleural effusion showed a significant relationship to the severity of pleural inflammation in terms of the following variables: LDH (rs = 0.4201, P= 0.001), adenosine deaminase (ADA) (rs = 0.4440, P= 0.0004), white blood cell count (rs = 0.4266, P= 0.0004), polymorphonuclear cell percentage (rs = 0.5080, P= 0.0001), and polymorphonuclear cell count (rs = 0.5095, P= 0.0002). In the parapneumonic effusion and empyema groups, the changes in pleural fluid CEA level exhibited a positive association with the changes in the pleural fluid ADA level (rs = 0.8143, P= 0.0002).



Conclusions:  The results from our series indicated that false positive results for pleural fluid CEA level were most commonly observed in patients with empyema and parapneumonic effusion and the CEA level showed a significant correlation to the indices of pleural inflammation. The serial measurement of pleural fluid CEA level may be useful as a means of monitoring resolution of pleural inflammation and excluding the possibility of a malignant pleural effusion.

Hye-Seung Han

Papers

The implication of elevated carcinoembryonic antigen level in pleural fluid of patients with non-malignant pleural effusion.