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Diagnostic accuracy of tumour markers in serous effusions: a validation study

  • Research Article
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Tumor Biology

Abstract

The utility of tumour markers (TM) in the differential diagnosis of cancer in serous effusion (fluid effusion (FE)) has been the subject of controversy. The aim of this study was to prospectively validate our previous study and to assess whether the addition of adenosine deaminase (ADA), C-reactive protein (CRP) or percentage of polymorphonuclear cells (%PN) allows the identification of false positives. In this study, carcinoembryonic antigen, cancer antigen 15-3, cancer antigen 19-9, ADA, CRP and %PN in FE were determined in 347 patients with 391 effusions. Effusions were considered as malignant effusion when at least one TM in serum exceeded the cutoff and the ratio FE/S was higher than 1.2. Also, cases with values of ADA, CRP and %PN above the established cutoffs in serous effusion were considered as potential false positives. The combined sensitivity and specificity of the three TM was 76.2 % (95 % confidence intervals (CI) 67.8–83.3 %) and 97.0 % (95 % CI 94.1–98.7), respectively. Subanalysis of the 318 cases with previous criteria and negative ADA, CRP and %PN obtained sensitivities of 78.4 % (95 % CI 69.4–85.6) and a specificity of 100 % (95 % CI 98.2–100). The results obtained validate our previous study and are improved with the addition of ADA, CRP and %PN. TM in serous effusions and serum could be useful for the diagnostic assessment of patients with serous effusions.

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Abbreviations

ADA:

Adenosine deaminase

CA125:

Cancer antigen 125

CA15-3:

Cancer antigen 15-3

CA19-9:

Cancer antigen 19-9

CEA:

Carcinoembryonic antigen

CI:

Confidence intervals

CRP:

C-reactive protein

CYFRA 21-1:

Cytokeratin 19 fragment

FE:

Fluid effusion

NPV:

Negative predictive value

PPV:

Positive predictive value

NLH:

Negative likelihood ratio

PLH:

Positive likelihood ratio

%PN:

Percentage of polymorphonuclear cells

S:

Serum

TM:

Tumour markers

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Acknowledgments

This study has been awarded the XIII prize of Bages de Ciències Mèdiques 2009, granted by the Fundació Acadèmia de Ciències Mèdiques de Catalunya i Balears, Bages branch. The authors also thank Sylva Astrik Torossian for the support to the manuscript edition and translation.

Conflicts of interest

None

Author information

Authors and Affiliations

  1. Service of Laboratory Medicine, Althaia, Xarxa Assistencial Universitària de Manresa, Dr. Joan Soler 1-3, 08243, Manresa, Catatonia, Spain

    Jaume Trapé, Josefina Franquesa & Joan López

  2. Service of Clinical Biochemistry, Hospital Clínic de Barcelona, Barcelona, Spain

    Rafael Molina

  3. Service of Pathology, Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Spain

    Francesc Sant & Josep Miquel Badal

  4. Service of Medical Oncology, Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Spain

    Jesús Montesinos & Montserrat Doménech

  5. Service of Epidemiology, Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Spain

    Anna Arnau

  6. Service of Pulmonary, Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Spain

    Rosana Blavia, Esperanza Martín, Emili Marquilles, Damià Perich & Concepción Pérez

  7. Service of Internal Medicine Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Spain

    Josep Maria Roca

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  1. Jaume Trapé
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Correspondence to Jaume Trapé.

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Trapé, J., Molina, R., Sant, F. et al. Diagnostic accuracy of tumour markers in serous effusions: a validation study. Tumor Biol. 33, 1661–1668 (2012). https://doi.org/10.1007/s13277-012-0422-3

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  • DOI: https://doi.org/10.1007/s13277-012-0422-3

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