The Value of Carcinoembryonic Antigen in Differentiating Malignant from Benign Pleural Effusion

癌胚胎抗原（CEA）於區分良性與惡性肋膜積水之應用價值

陳奕仁(I-Jen Chen) ； 陳昌文(Chang-Wen Chen) ； 郭浩然(How-Ran Guo) ； 林明憲(Ming-Shian Lin) ； 薛尊仁(Tzuen-Ren Hsiue)

《胸腔醫學》 18卷2期 (2003/04) Pp. 110-115

摘要

前言：良性或是惡性之肺部疾病都會導致肋膜積水，因此區分其病因是很重要的。我們試著去分析在肋膜積水中的癌胚胎抗原（CEA），淋巴球所佔比例，及一些生化檢驗，看是否能從其中發現有助於區分良性或惡性疾病所引起的肋膜積水。
材料與方法：我們蒐集過去五年來的79個病例，包括21個惡性積水，16個惡性疾病引起的積水，19個結核性積水，及23個其他良性疾病引起的積水。癌胚胎抗原的測定是使用chemiluscence immunoassay。血球分類及計數是利用Liu’s stain於顯微鏡下檢驗。生化值的測定則是利用自動生化分析器。除了良性與惡性疾病的比較外，由於結核性積水與惡性疾病的肋膜積水，都是屬於淋巴球為主的積水，我們也將肺結核與惡性疾病的肋膜積水加以比較。
結果：於惡性疾病積水的病例群中，癌胚胎抗原值的確較其他病例具有統計意義的升高。當設定癌胚胎抗原值為10 ng/ml時，其偵測惡性疾病的敏感性及特異性分別是0.65及0.98。若合併細胞學檢查使用時，其敏感性可進一步提升至0.73。
結論：分析肋膜積水中之癌胚胎抗原值，對於偵測惡性疾病時，能有可接受的敏感性及很高的特異性。

關鍵字

肋膜積水 ； 癌胚胎抗原 ； 肋膜積水

並列摘要

Objectives: Pleural effusion may result from both malignant and benign pulmonary conditions, and is very important in making the differential diagnosis. Some biomarkers in the pleural effusion may help the process. We conducted a study to evaluate the feasibility of using carcinoembryonic antigen (CEA), proportion of lymphocytes, and various biochemical parameters in pleural effusion to differentiate between benign and malignant diseases.
Materials and Methods: Samples of pleural effusion were obtained from 79 patients, including 21 with malignancies, 16 with paramalignant conditions, 19 with tuberculosis, and 23 with other benign diseases. CEA was measured using chemiluminescence immunoassay, and complete and differential cell counts were conducted by microscopic examination with Liu’s stain. Biochemical parameters were measured with an autoanalyzer. In addition to the comparison of the benign and malignant groups, we also compared these parameters between patients with tuberculosis and those with malignancy, as both have exudative effusion with lymphocyte predominance.
Results: The CEA level was higher in patients with malignant effusion (76.3+121.4 ng/ml vs. 1.9+2.1 ng/ml, p ＜ 0.001 with the Mann-Whitney U test) than in those with benign effusion. With a cut-off level of 10 ng/ml, the sensitivity and specificity of CEA for diagnosing malignancy were 0.65 and 0.98, respectively. Together with cytology, the sensitivity could be raised to 0.73.
Conclusion: The CEA assay of pleural effusion had an acceptable sensitivity and a high specificity in differentiating malignant from benign effusion.

並列關鍵字

pleural effusion ； carcinoembryonic antigen ； pleural effusion