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Research ArticleClinical Studies

Diagnostic Accuracy of Pleural Fluid Cytology, Carcinoembryonic Antigen and C-Reactive Protein Together in Patients With Pulmonary Metastases and Malignant Pleural Effusion

STEFANO M.M. BASSO, ALESSANDRO DEL CONTE, UMBERTO ZUCCON, SANDRO C. SULFARO, GIOVANNI FANTI, FEDERICA MAFFEIS, PAOLO UBIALI, MARIO ERMANI and FRANCO LUMACHI
Anticancer Research October 2020, 40 (10) 5877-5881; DOI: https://doi.org/10.21873/anticanres.14607
STEFANO M.M. BASSO
1Department of Surgery, General Surgery, S. Maria degli Angeli Hospital, Pordenone, Italy
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  • For correspondence: Drsteba@tin.it
ALESSANDRO DEL CONTE
2Medical Oncology and Immune-Related Tumors, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Pordenone, Italy
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UMBERTO ZUCCON
3Department of Medicine, Pneumology, S. Maria degli Angeli Hospital, Pordenone, Italy
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SANDRO C. SULFARO
4Department of Laboratory Medicine, Pathology and Histopathology Section, S. Maria degli Angeli Hospital, Pordenone, Italy
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GIOVANNI FANTI
1Department of Surgery, General Surgery, S. Maria degli Angeli Hospital, Pordenone, Italy
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FEDERICA MAFFEIS
1Department of Surgery, General Surgery, S. Maria degli Angeli Hospital, Pordenone, Italy
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PAOLO UBIALI
1Department of Surgery, General Surgery, S. Maria degli Angeli Hospital, Pordenone, Italy
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MARIO ERMANI
5Department of Neurosciences, Statistic and Informatics Unit, University of Padua, School of Medicine, Padua, Italy
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FRANCO LUMACHI
6University of Padua, School of Medicine, Padua, Italy
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Abstract

Background/Aim: Pleural effusion (PE) has a heterogeneous aetiology, and differential diagnosis between benign and malignant disease may require invasive procedures in up to 60% of cases. The sensitivity of pleural cytology is limited, and several strategies have been tested to reduce the need of invasive diagnostic approaches. The aim of this study was to evaluate the usefulness of pleural fluid cytology, compared to, and combined with, carcinoembryonic antigen (CEA), C reactive protein (CRP), and lactate dehydrogenase (LDH) assay of pleural fluid (PF) in patients with a history of cancer, exudative non-purulent PE, and suspicion of malignant PE on imaging studies. Patients and Methods: The medical records of 40 patients with pulmonary metastases and malignant PE, and 57 controls with benign exudative PE were reviewed. All the patients underwent pleural cytology and CEA, CRP, and LDH assay before VATS-guided biopsy. Results: The sensitivity and specificity were 55.0% and 98.2% (cytology), 35.0% and 98.2% (CEA), 92.5% and 71.9% (CRP), 70.0% and 54.4% (LDH). The multivariate analysis excluded LDH, and the final AUC (cytology+CEA+CRP) was 0.894. Conclusion: In all patients with a history of cancer and PE of uncertain origin, the combination of PF cytology plus pleural CEA and CRP assay together should be suggested to recognize malignant plural effusion (MPE), minimising the use of unnecessary invasive investigations.

  • Pleural effusion
  • pulmonary metastases
  • pleural cytology
  • CEA
  • CRP
  • LDH
  • predictive model
  • Received July 18, 2020.
  • Revision received August 2, 2020.
  • Accepted August 3, 2020.
  • Copyright© 2020, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved
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Anticancer Research: 40 (10)
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Diagnostic Accuracy of Pleural Fluid Cytology, Carcinoembryonic Antigen and C-Reactive Protein Together in Patients With Pulmonary Metastases and Malignant Pleural Effusion
STEFANO M.M. BASSO, ALESSANDRO DEL CONTE, UMBERTO ZUCCON, SANDRO C. SULFARO, GIOVANNI FANTI, FEDERICA MAFFEIS, PAOLO UBIALI, MARIO ERMANI, FRANCO LUMACHI
Anticancer Research Oct 2020, 40 (10) 5877-5881; DOI: 10.21873/anticanres.14607

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Diagnostic Accuracy of Pleural Fluid Cytology, Carcinoembryonic Antigen and C-Reactive Protein Together in Patients With Pulmonary Metastases and Malignant Pleural Effusion
STEFANO M.M. BASSO, ALESSANDRO DEL CONTE, UMBERTO ZUCCON, SANDRO C. SULFARO, GIOVANNI FANTI, FEDERICA MAFFEIS, PAOLO UBIALI, MARIO ERMANI, FRANCO LUMACHI
Anticancer Research Oct 2020, 40 (10) 5877-5881; DOI: 10.21873/anticanres.14607
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Keywords

  • pleural effusion
  • pulmonary metastases
  • pleural cytology
  • CEA
  • CRP
  • LDH
  • predictive model
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