For the best experience on htmlWebpackPlugin. El CEA se produce normalmente durante el desarrollo del feto. La muestra de sangre se toma de una vena del brazo. Es posible que la sienta apretada.
|Published (Last):||5 September 2015|
|PDF File Size:||17.13 Mb|
|ePub File Size:||5.94 Mb|
|Price:||Free* [*Free Regsitration Required]|
Back to Summary. J Bras Pneumol. Introduction The etiological diagnosis of pleural effusion is frequently a problem in clinical practice, especially in terms of the differentiation between malignant and benign pleural effusion, due to the significant difference in the treatment and prognosis involved.
Therefore, cytokeratin 19 fragment CYFRA presents good sensitivity for non-small cell bronchogenic carcinomas, especially those of the squamous type 5,11 ; levels of carbohydrate antigen CA are often elevated in patients with advanced breast cancer 11 ; and levels of carcinoembryonic antigen CEA are elevated in various malignant diseases, especially those of epithelial origin.
Although there are a number of studies in the international literature involving the analysis of biological tumor markers in pleural fluid as a means of identifying associations with thoracic neoplasms, only a few such studies have been conducted in Brazil, 6,12 and we found no studies in which biological tumor markers were analyzed in more than one type of biological material simultaneously.
Therefore, our objective was to evaluate the determination of the tumor markers CEA, CYFRA and CA in blood and pleural fluid of patients with pleural effusion without previous diagnostic investigation, as well as to assess their usefulness as auxiliary methods of differentiating between benign and malignant cases.
Methods Population studied The population was composed of 85 consecutive patients referred to the pulmonology sector of a university hospital, over an eight-month period, for the investigation of pleural effusion. All patients agreed to participate in the study and gave written informed consent. Three patients refused to allow the collection of blood samples but agreed to allow the collection of biological material through pleural puncture. None of the patients had previously been investigated in terms of the pleural effusion, nor were any of them being treated for malignant disease with chemotherapy or radiotherapy or for tuberculosis with anti-tuberculosis drugs.
In the differentiation between exudates and transudates, we used the criteria established by Light. The evaluation of the pleural effusion was considered inconclusive when the cytopathologic study of the pleural fluid and the morphologic examination of the pleura did not indicate the cause of the pleural effusion.
These cases were not included in the determination of the markers. Collection of biological material Blood samples were simultaneously collected to determine the levels of tumor markers and the biochemical levels of lactate dehydrogenase, albumin, and total proteins.
Percutaneous thoracic puncture was used to collect the pleural fluid, which was sent for biochemical testing, leukocyte measurement, culture, and smear cytology. Pleural biopsy was performed in the exudates for an anatomopathological study. When the level of a given marker surpassed the detection limit of the method, a dilution of was used. Statistic methodology In the data analysis, associations between categorical variables were evaluated using the Fisher-Freeman-Halton exact test.
The comparison between the values for two markers, in serum and in pleural fluid, was carried out using the Mann-Whitney test. In the construction of the ROC curves, the patients with malignant effusion were considered cases, and the patients with benign effusion were considered controls. The effectiveness of the combination of the three markers to distinguish between malignant and benign effusion was evaluated by constructing multivariate logistic regression models.
The response variable was composed of the two categories of pleural effusion malignant or benign , and malignant effusion was the category of interest from the prediction point of view. Results Of the 85 patients studied, 36 The results were inconclusive in 19 Table 1 shows the distribution of the patients by age and gender. The etiologic diagnoses of the cases of pleural effusion can be seen in Table 2.
The inconclusive cases were not evaluated. In the benign cases, tuberculosis prevailed. The cytology of the pleural fluid provided the diagnosis in 25 Under that condition, it was determined that, in the pleural fluid, the greatest sensitivity was achieved with the combination of CYFRA and CEA When all three markers were used in conjunction, the sensitivity increased to Discussion Recognizing patients with pleural malignancy if fundamental, since, unlike those with the benign form, for whom the prognosis is favorable, such patients have a mean survival of three to six months.
There was a discrete predominance of malignant pleural effusion This reflects the high prevalence of tuberculosis in Brazil, and the most common presentation of extrapulmonary tuberculosis is the pleural form. Among the potential factors responsible for this difficulty are the inappropriate collection and laboratory manipulation of the pleural fluid, as well as an insufficient quantity of pleural material.
The potential of using such markers to differentiate between malignant and benign effusions has been mentioned in various studies. Although some studies have employed a single tumor marker, the combination of more than one marker raises their sensitivity in detecting malignant neoplasms. However, some authors have reported that the concentrations of tumor markers are greater in the pleural fluid than in the serum, suggesting the local production of some markers, especially those such as CYFRA secreted by mesothelial cells , which might alter the overall sensitivity of the marker.
When the three markers were used in conjunction in the pleural fluid samples, the sensitivity increased to This finding is in agreement with those of other studies. The levels of CYFRA and CEA were higher in pleural fluid than in serum p For all of the markers studied, there were statistically significant differences between the serum and pleural fluid samples, as well as between the malignant and benign forms of pleural effusion.
These results are similar to what has been found in other studies. A similar result was found by some authors. In the present study, no statistically significant differences were found among the smokers, former smokers and nonsmokers in terms of the tumor marker levels, whether in serum or in pleural fluid.
The determination of tumor marker levels is not routinely indicated. However, in cases of suspected malignancy and inconclusive initial findings, tumor marker levels should be determined prior to the performance of invasive procedures, thereby optimizing the cost-benefit ratio.
The present study represents an advance in the investigation of pleural effusion at our facility. Our findings demonstrate that determining serum and pleural fluid levels of the tumor markers CYFRA, CEA, and CA is useful in differentiating between benign and malignant pleural effusion.
References 1. Light RW. Pleural effusion related to metastatic malignancies. In: Light RW, editor. Pleural Diseases. Philadelphia: Lippincott; Loddenkemper R. Thoracoscopy-state of the art. Eur Respir J. American Thoracic Society. Management of malignant pleural effusion. Sahn SA. Pleural diseases related to metastatic malignancies. Gross JL. Evaluation of seven tumour markers in pleural fluid for the diagnosis of malignant effusions.
Ferrer JS. Arch Bronconeumol. Buccheri G, Ferrigno D. Lung tumor markers of cytokeratin origin: an overview. Lung Cancer. Malkin A. Tumor Makers. In: Tannock I, Hill R, editors. The basic science of oncology. Baskerville: McGraw-Hill; Braga ACO. Rio de Janeiro: Universidade Federal Fluminense, Effect of age and cigarette smoking on carcinoembryonic antigen levels.
Pleural effusion. N Engl J Med. Light, RW. A new classification of parapneumonic effusions and empyema. Agresti A. An introduction to categorical data analysis. Applied logistic regression. New York: John Wiley and Sons; Diagnosis and management of malignant pleural effusions. Am J Surg. Comparison of needle biopsy with cytologic analysis for the evaluation of pleural effusion: analysis of cases.
Mayo Clin Proc. Diagnostic utility of CYFRA , carcinoembryonic antigen, CA , neuron specific enolase, and squamous cell antigen level determinations in the serum and pleural fluid of patients with pleural effusions. Clinical evaluation of the simultaneous determination of tumor markers in fluid and serum and their ratio in the differential diagnosis of serous effusions. Tumor Biol ;25 Sociedade Brasileira de Pneumologia e Tisiologia. Rio de Janeiro; Seiscento M, Bombarda S.
Derrame Pleural. The etiology of pleural effusions in area with high incidence of tuberculosis. The implication of elevated carcinoembryonic antigen level in pleural fluid of patients with non-malignant pleural effusion.
Evolution of idiopathic pleural effusion: a prospective, long-term follow-up stu dy. Diagnostic value of CA in pleural fluid.