Clinical Efficacy of Cisplatin Intrapleural Perfusion with Pemetrexed Disodium for Lung Adenocarcinoma with Malignant Pleural Effusion and its Influence on Pleural Effusion Carcinoembryonic Antigen Levels

Malignant pleural effusion is usually caused by lung cancer, and tumor markers may be helpful to its differential diagnosis. The aim of this study is to explore the clinical value of serum and pleural effusion pro-gastrin-releasing peptide (ProGRP), neuron specific enolase (NSE), cyto- keratin fragment 19 (CYFRA21-1) and carcinoembryonic antigen (CEA) in differential diagnosis and histological typing of malignant pleural effusion caused by lung cancer. According to histological type of primary tumor, 99 patients with malignant pleural effusion caused by lung cancer were divided into small cell lung cancer (SCLC) group, adenocarcinoma group and squamous cell carcinoma group, with 37 patients with benign pleural effusion and 35 healthy persons as controls. Diagnostic value of serum and pleural effusion ProGRP , NSE, CYFRA21-1 and CEA was evaluated for each group. The levels of ProGRP, NSE, CYFRA21-1 and CEA in serum and pleural effusion of all the malignant groups were significantly higher than those in the control groups (P < 0.01). In the SCLC group, detection of pleural effusion ProGRP showed the highest Youden index and accuracy. In the adenocarcinoma group and squamous cell carcinoma group, combined detection of pleural effusion CEA+CYFRA21-1 (on parallel test) showed the highest Youden index and accuracy. Detection of pleural effusion tumor markers ProGRP, CYFRA21-1, NSE and CEA is of great clinical value in differential diagnosis and histological typing of malignant pleural effusion. Pleural effusion ProGRP is the optimal tumor marker for malignant pleural effusion caused by SCLC. Pleural effusion CEA+CYFRA21-1 (on parallel test) is a good auxiliary diagnosis index for malignant pleural effusion caused by adenocarcinoma and squamous cell carcinoma of the lung.

Objective: To evaluate the value of combined detection of negative costimulatory molecule B7-H4 and carcinoembryonic antigen (CEA) in diagnosing malignant and benign pleural effusion. Methods: Ninety-seven pleural effusion specimen were collected, 55 of which were diagnosed as malignant pleural effusion and 42 were benign pleural effusion. Enzyme-linked immunosorbent assay(ELISA) was used to examine the concentration of B7-H4 and CEA in pleural effusion. Electro-chemiluminescence immunoassay was used to detect the CEA level in pleural effusion. Receiver operating characteristic (ROC) curve was established to analyze and evaluate the single or combined detection of B7-H4 and CEA in diagnosing malignant and benign pleural effusion. Results: The concentrations of B7-H4 and CEA in malignant pleural effusion (MPE) group were (60.08±35.04) ng/ml and (41.49±37.16) ng/ml, respectively, obviously higher than (27.26±9.55) ng/ml and (2.41±0.94) ng/ml of benign pleural effusion (BPE) group (both P<0.01). Area under curve (AUC) of B7-H4 was 0.884 in MPE groupand the diagnostic sensitivity and specificity were 81.8% and 90.5%, respectively, at the optimized cut off value of 37.25 ng/ml. Likewise, area under curve (AUC) of CEA was 0.954 and the sensitivity and specificity were 87.3% and 95.2%, respectively, at the cut off value of 4.18 ng/ml. When B7-H4 >37.25 ng/ml or CEA>4.18 ng/ml, the sensitivity of diagnosis as MPE was down-regulated to 90.9% and the specificity was elevated to 88.1%. When B7-H4 >37.25 ng/ml and CEA>4.18 ng/ml, the sensitivity of diagnosis as MPE was down-regulated to 78.2% and the specificity was elevated to 97.6%. The sensitivity and specificity of combined detection of B7-H4 and CEA to diagnose MPE were elevated to 90.9% and 97.6%, respectively. The level of B7-H4 in MPE and BPE were both positively correlated with CEA (r=0.670, P=0.001 in MPE and r=0.002, P=0.001 in BEP). Conclusions: B7-H4 is a potential tumor marker in diagnosing the benign and malignant pleural effusion. Although the diagnostic value of B7-H4 may not precede to CEA, the combined detection of B7-H4 and CEA can improve the diagnostic sensitivity and specificity of MPE.

Objective To evaluate the differential diagnostic values of combined detection of adenosine de aminase (ADA),carcinoembryonic antigen (CEA),carbohydrate antigen 153 (CA153),neuron-specific enolase (NSE) and carbohydrate antigen 199 (CA199) in patients with pleural effusion.Methods Serum and hydrothorax fluid of CEA,CA153,NSE and CA199 in patients with plearal effusion were measured by electrochemiluminescence assay(ECLA),ADA from pleural effusions were measured by enzyme rate assay,and the clinical value of combined detection in the differential diagnosis of pleural effusion was evaluated.Results The levels of ADA(65.89±19.81 U/L) in hydrothorax fluid group with tuberculous pleural effusion were beth higher than those in the groups with inflammatory pleural effusion (17.33±16.58) U/L and malignant pleural effusion(27.44±22.64) U/L (q=12.19 and 10.72,P＜0.01).The positive rate of A DA was 82.88% (29/135) in hydrothorax fluid group with tuberculous pleural effusion,13.41% (11/135) in malignant pleural effusion and 11.11% (2/135) in inflammatory pleural effusion (X~2=59.07,P＜0.01).The levels and positive rate of CEA,CA153,NSE,and CA199 in serum and hydrothorax fluid group with malignant pleural effusion were both higher than those in the group with tuberculous pleural effusion (P＜0.05).Compared with the group with malignant pleural effusion,the levels of CA153 and CA199 in serum and the levels and the positive rate of NSE in serum and hydrothorax fluid were not statistically different in inflammatory pleural effusion group.In the 82 cases with malignant pleural effusion,the positive rate of the four kinds of serum tumor markers including CEA,CA153,NSE and CA199 was 74.39% (61/82) and the positive rate of those hydrothorax fluid tumor markers was 82.93% (68/82).Conclusions Combined detection of ADA,CEA,CA153,NSE and CA199 is of some significance to the differential diagnosis of pleural effusion. Key words: Pleural effusion; Adenosine deaminase; Carcino embryonic antigen; Carbohydrate antigen 153; Neurone-specific enolase; Carbohydrate antigen 199

AimTo investigate the diagnostic value of combined detection of SHOX2 and RASSF1A gene methylation with carcinoembryonic antigen (CEA) level in diagnosing malignant pleural effusion.MethodsBetween March 2020 and December 2021, we enrolled 68 patients with pleural effusion admitted to the Department of Respiratory and critical care medicine of Foshan Second People's Hospital. The study group included 35 cases of malignant pleural effusion and 33 cases of benign pleural effusion. Methylation of the short homeobox 2 genes (SHOX2) and RAS-related region family 1A gene (RASSF1A) in pleural effusion samples were detected by real-time fluorescence quantitative PCR, and the level of carcinoembryonic antigen (CEA) in pleural effusion samples was detected by immune flow cytometry fluorescence quantitative chemiluminescence.ResultsSHOX2 or RASSF1A gene methylation was detected in 5 cases in the benign pleural effusion group and 25 patients in the malignant pleural effusion group. The positive rate of SHOX2 or RASSF1A gene methylation in the malignant pleural effusion group was significantly higher than in the benign pleural effusion group (71.4% vs. 15.2%, P < 0.01). Positive CEA (CEA > 5 ng/m) was detected in 1 case in the benign pleural effusion group and 26 patients in the malignant pleural effusion group. The CEA-positive rate in the malignant pleural effusion group was significantly higher than in the benign pleural effusion group (74.3% vs. 3%, P < 0.01). When SHOX2 and RASSF1A gene methylation was combined with CEA detection, 6 cases were positive in the benign pleural effusion group, and 31 patients were positive in the malignant pleural effusion group. The positive rate of combined detection in the malignant pleural effusion group was significantly higher than in the benign pleural effusion group (88.6% vs. 18.2%, P < 0.01). The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and Youden’s index of SHOX2, RASSF1A gene methylation combined with CEA in diagnosing malignant pleural effusion were 88.6%, 81.8%, 85.3%, 83.8%, 87.1% and 0.7 respectively.ConclusionThe combined detection of SHOX2 and RASSF1A gene methylation with CEA level in pleural effusion has a high diagnostic value for malignant pleural effusion.

Objective To explore the clinical value of pleural fluid combined with serum indicators for the diagnosis of tuberculous, malignant and nonspecific inflammatory pleural. Methods The complete medical records of 408 cases enrolled in this research were analyzed. Patients were divided into tuberculous pleural effusion group (tuberculosis group, n=200) , malignant pleural effusion group (carcinoma group, n=64) and parapneumonia pleural effusion group (inflammatory group, n=144). The general clinical characteristics and related indicators of patients were analyzed, and multiple linear regression model was established. Results The tuberculous pleural effusion was mainly seen in the people under 50 years old (76.00%) with more females than males (0.56∶1). There were 196 patients (98.00%) with chest pain in tuberculosis group. The malignant and inflammatory pleural effusion were mainly seen in the people over 50 years old (75.00% and 72.22%) with more males than females (1.67∶1 and 1.77∶ 1). There were only 24 patients (37.50%) in carcinoma group and 24 patients (16.67%) in inflammatory group with chest pain. Among 3 groups, the serum procalitonin (PCT) increased obviously in inflammatory group, the pleural effusion carcinoembr yonicantigen (CEA) and lactate dehydrogenase (LDH) increased obviously in carcinoma group, and the serum erythrocyte sedimentation rate (ESR) and pleural effusion adenosine deaminase (ADA) increased obviously in tuberculosis group. Their differences had statistical significances (F=5.327, 21.442, 10.497, 4.687 and 7.562, P all<0.05). Multiple linear regression analysis indicated that pleural effusion ADA, CEA and serum PCT had diagnostic value to tuberculosis pleural fluid (t=3.595, -2.267 and -2.164, P all <0.05); pleural effusion CEA, LDH and ADA had diagnostic value to malignant pleural effusion (t=7.258, 5.464 and -4.119, P all < 0.01); serum PCT, pleural effusion LDH and CEA had diagnostic value to inflammatory pleural effusion (t=3.388, -4.624 and -2.164, P all<0.01). Conclusions The increase of serum PCT and pleural effusion CEA is helpful to eliminate tuberculous pleural fluid. High levels of pleural effusion CEA, LDH and low level of pleural effusion ADA are helpful to diagnose malignant pleural fluid. High level of pleural effusion CEA and low levels of pleural effusion LDH and CEA are helpful to diagnose inflammatory pleural fluid. Key words: Pleural effusion; Diagnosis; Multiple linear regression

Objective To disscuss the value of medical thoracoscopy in the diagnosis of malignant pleural effusion and probe the clinical significance of the diagnosis of malignant pleural effusion of the level of carcinoembryonic antigen (carcino-embryonic antigen, CEA) in pleural fluid, serum. Methods We analyzed retrospective the clinical data of 77 patients with pleural effusion during August 2015 to August 2016.We took the medical thoracoscope pathological results as the gold standard and evaluated the value of the level of CEA in pleural effusion and in serum and the pleural effusion/serum CEA ratio to diagnosis malignant pleural effusion. Results ①Among the 77 patients with pleural effusion, medical thoracoscope could clearly diagnosis 74 of them (46 of them were with malignant pleural effusion, 27 of them were with tuberculous pleural effusion, 3 of them were with pneumonia pleural effusion in cases, one was with nonspecific inflammation incase), the diagnostic rate was 96.1%.②The level of CEA in serum、in pleural effusion and the pleural effusion/serum CEA ratio in the malignant pleural effusion groupobviously were higher than that in pleural effusion group.Therefore, the level of CEA in pleural effusion of ladenocarcinoma were significantly higher than thoseother types of pleural effusion.③The sensitivity of the CEA in pleural effusion, specificity and accuracy ratio (80.4%, 89.3%, 83.7%) were higher than that in serum CEA and the pleural effusion/serum CEA ratio (56.5%, 78.5% and 64.9%, respectively, 93.4%, 64.2%, 82.4%). Conclusions ①Medical thoracoscopy is a safe, effective, practical diagnosis method which is worth to popularizing widely.②The CEA levels in the body, especially in pleural effusion, is significant to diagnosis the malignant pleural effusion(especially in adenocarcinoma). It can be used as an auxiliary diagnostic index for clinical application. Key words: Pleural effusion, malignant; Medical thoracoscopy; The CEA in serum; The CEA in pleural effusion; Pleural effusion/serum CEA ratio

Many studies have proved that carcinoembryonic antigen (CEA) and cancer antigen 125 (CA125) have high affinity and binding specificity, and can be used to distinguish pleural effusion in patients with malignant and non-malignant pleural effusion. So, investigated whether tumour markers carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), cancer antigen 125 (CA-125), and cytokeratin 19 fragment (CYFRA 21-1) in pleural effusions and serum is most important. Patients and methods: This Observational Descriptive Cross Section study. was carried out in Chest diseases department at Zagazig University Hospitals on 70 cases with pleural malignancies started from June Months 2023 to January 2024. Pleural fluid CEA was done using electrochemiluminescence immunoassay (ECLIA) (Sandwich principle). CA125 was measured in pleural fluid in U/ml using the commercially available ELISA kit. Results: There was a significant higher cancer antigen 125 and a carcinoembryonic antigen in malignant compared to benign pleural effusion. Cancer Antigen 125 (Ca125) at cut off ≥12 and carcinoembryonic antigen at cut off level ≥3: show sensitivity 97.1%, specificity 60.0% and accuracy 78.6% to discriminate malignant pleural effusion from benign pleural effusion. This indicated that both cancer antigen 125 (Ca125) & carcinoembryonic antigen give highly suspicious of malignancy but poor specificity. Conclusions: In cases of malignant effusion the level of Ca-125 and CEA are significantly higher in pleural fluid. CA125, and CEA markers proved to be highly effective as malignant markers, might be useful in the differentiation between malignant and benign effusions.

Objective To investigate the value of paraffin-embedded section of cell block in the diagnosis of benign or malignant pleural and peritoneal effusion. Methods 105 patients suspected with malignant pleural and peritoneal effusion admitted into tour hospital from November, 2015 to December, 2017 were selected as the research objects. The specimens of pleural and peritoneal effusion of all the patients were collected. And these specimens were given paraffin-embedded section of cell block, cell smear, and exfoliative cell pathological examination. The results of exfoliative cell pathological examination were taken as the gold standard. The positive rates of malignant pleural and peritoneal effusion diagnosed by paraffin-embedded section of cell block and cell smear were evaluated. The diagnostic value of the two methods was compared. Results Among the 50 pleural effusion specimens, the results of exfoliative cell pathological examination showed that there were 36 cases of malignant pleural effusion. Among the 55 peritoneal effusion specimens, the results of exfoliative cell pathological examination showed that there were 42 cases of malignant peritoneal effusion. The positive detection rate of pleural effusion diagnosed by paraffin-embedded section of cell block (80.56%) was higher than that diagnosed by cell smear (58.33%), with a statistical difference (P<0.05). The positive detection rate of peritoneal effusion diagnosed by paraffin-embedded section of cell block (85.71%) was higher than that diagnosed by cell smear (64.29%), with a statistical difference (P<0.05). The sensitivity, specificity, and accuracy of paraffin-embedded section of cell block in the diagnosis of malignant pleural and peritoneal effusion were higher than those of cell smear, with statistical differences (all P<0.05). Conclusions Paraffin-embedded section of cell block in the differential diagnosis of benign or malignant pleural and peritoneal effusion has high sensitivity and specificity, and can increase the diagnostic accuracy and provide an important basis for clinical diagnosis and treatment of the disease. Key words: Pleural effusion; Paraffin-embedded section of cell block; Cell smear; Exfoliative cell pathological examination

Objective To investigate the significance of combined detection of tumor markers in serum and pleural fluid on differential diagnosis of benign and malignant pleural effusion.Methods Three hundred and seventy six cases of pleural effusion were selected.The levels of carcinoembryonic antigen (CEA),neuronspecific enolase(NSE),cancer antigen 125 ( CA125 ),squamous cell carcinoma antigen (SCC) in serum and pleural fluid were examined and they were analyzed combined with histological or cytological evidence using statistical methods.Results There were 298 cases in malignant group and 98 cases in benign group.The levels of the four tumor markers in malignant group were significantly higher than in benign group both in pleural fluid (CEA:[279.9 ± 170.0]μg/L v.s.[ 12.6 ± 6.2 ] μg/L,t =6.29,P ＜ 0.01; NSE:[ 112.3 ± 86.8 ] μg/L v.s.[14.7 ±7.3] μg/L,t =5.13,P ＜0.01 ;SCC:[ 10.6 ± 5.4] μg/L v.s.[ 1.2 ±0.6 ] μg/L,t =2.34,P ＜0.01;CA125:[ 409.2 ± 206.7] U/ml v.s.[ 44.0 ± 20.5 ] U/ml,t =7.46,P ＜ 0.01 ) and in serum ( CEA:[ 86.7 ±42.0] μg/L v.s.[6.2±3.1]μg/L,t=3.14,P＜0.01;NSE:[31.6±18.2]μg/Lv.s.[11.2±5.0]μg/L,t=4.61,P＜0.01;SCC:[3.5±2.2]μg/Lv.s.[1.8±0.g]μg/L,t=1.70,P＜0.01;CA125:[134.0±72.6]U/ml v.s.[ 19.8 ± 9.6 ] U/m1,t =4.04,P ＜ 0.01 ).Moreover,the levels of tumor markers in pleural fluid were higher than in serum.The sensitivity were 100％ by combined detection of pleural fluid and serum tumor markers in parallel and the specificity were 100％ in sequence.Conclusion The levels of CEA,NSE,CA125,SCC in pleural effusion were more sensjtive than which in serum.Combined detection of tumor markers in pleural fluid and serum could improve the sensitivity of diagnosis for benign and malignant pleural effusion. Key words: Pleural fluid; Tumor markers; Carcinoemhryonic antigen; Neuron-specific enolase; Cancer antigen 125 ; Squamous cell carcinoma antigen

Background:Pleural effusion (PE) is presenting symptoms of many different diseases and is often a diagnostic challenge. Negative cytology in the malignant PE requires more complicated diagnostic procedures, such as closed pleural biopsy or thoracoscopic pleural biopsy. Not all the patients will be fit for such invasive procedures due to high risk. Tumor markers seem to be a promising alternative and have been proposed to aid in the differentiation of the PE etiology.Objective:The objective of the study was to evaluate the diagnostic value of pleural fluid carcinoembryonic antigen (CEA) in differentiation between malignant and nonmalignant PEs and to compare adenosine deaminase (ADA) levels with respect to malignant and nonmalignant PE.Methodology:It was a prospective observational study. Patients who presented with undiagnosed exudative PE during the time period 2016–2018 were studied. Pleural fluid was subjected to all routine investigations such as sugar, protein, lactate dehydrogenase, ADA, and CEA.Results:A total of 100 patients were included in the study. Fifty-one patients had malignancy. Univariate analysis showed that smoker, previous history of cancer, ADA <20, and CEA of >2.15 were variables associated with malignancy. Multivariate analysis showed pleural fluid CEA >2.15 as only independent risk factor associated with malignancy. The sensitivity of 91.5% and 65% and specificity of 92.5% and 81.4%, respectively, were found for CEA 2.15 ng/dl and ADA <16.5 U/L as plotted from receiver operating characteristic curve. The combined CEA and ADA (2.39 ng/ml and 16.5 U/L) values in pleural fluid had higher sensitivity of 100%.Conclusion:Our study demonstrated that pleural fluid CEA levels have a sensitivity of 93.5% and specificity of 73% in diagnosing of malignant PE. ADA levels lesser than 16.5 U/L were seen in patients with malignant PE, but less sensitive and specific compared to CEA. Combined ADA and CEA levels had higher sensitivity than CEA alone.

To explore the diagnostic value of joint detection of soluble B7-H4 (sB7-H4) and carcinoembryonic antigen (CEA) in identifying malignant pleural effusion (MPE) from benign pleural effusion (BPE). A total of 97 patients with pleural effusion specimens were enrolled from The First Affiliated Hospital of Zhengzhou University between June 2014 and December 2015. All cases were categorized into malignant pleural effusion group (n=55) and benign pleural effusion group (n=42) according to etiologies. Enzyme-linked immunosorbent assay was applied to examine the levels of sB7-H4 in pleural effusion and meanwhile CEA concentrations were detected by electro-chemiluminescence immunoassays. Receiver operating characteristic (ROC) curve was established to assess the diagnostic value of sB7-H4 and CEA in pleural effusion. The correlation between sB7-H4 and CEA levels was analyzed by Pearson's product-moment. The concentrations of sB7-H4 and CEA in MPE exhibited obviously higher than those of BPE ([60.08±35.04] vs. [27.26±9.55]ng/ml, P=.000; [41.49±37.16] vs. [2.41±0.94]ng/ml, P=.000). The AUC area under ROC curve of sB7-H4 and CEA was 0.884 and 0.954, respectively. Two cutoff values by ROC curve analysis of sB7-H4 36.5ng/ml and CEA 4.18ng/ml were obtained, with a corresponding sensitivity (81.82%, 87.28%), specificity (90.48%, 95.24%), accuracy (85.57%, 90.72%), positive predictive value (PPV) (91.84%, 96.0%), negative predictive value (NPV) (79.17%, 85.11%), positive likelihood ratio (PLR) (8.614, 18.327), and negative likelihood ratio (NLR) (0.201, 0.134). When sB7-H4 and CEA were combined to detect pleural effusion, it obtained a higher sensitivity 90.91% and specificity 97.62%. Furthermore, correlation analysis result showed that the level of sB7-H4 was correlated with CEA level (r=.770, P=.000). sB7-H4 was a potentially valuable tumor marker in the differentiation between BPE and MPE. The combined detection of sB7-H4 and CEA could improve the diagnostic sensitivity and specificity for MPE.

ABSTRACTObjectives: The diagnosis of malignant pleural effusion (MPE) remains a clinical challenge. As a negative regulator of T-cell activation, cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) has been associated with many malignant diseases. However, there is limited data about the relationship between CTLA-4 and MPE. The present study aims to investigate whether CTLA-4 levels may correlate with presence of MPE and to assess its potential diagnostic accuracy relative to that of the established markers carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (CYFRA21–1).Methods: Pleural effusion samples were collected from 36 patients with MPE and 48 patients with benign pleural effusion (BPE). Pleural levels of CTLA-4 were measured by ELISA; levels of CEA and CYFRA 21-1, by electrochemiluminescence immunoassay. Receiver operating characteristic curves were calculated to evaluate the ability of CTLA-4, CEA and CYFRA 21-1 to differentiate MPE from BPE.Results: Pleural levels of CTLA-4 were significantly higher in MPE than in BPE patients (471.73 ± 378.86 vs. 289.22 ± 173.67 pg/ml, p = 0.004). At a cut-off value of 351.25 pg/ml, the sensitivity and specificity of CTLA-4 in diagnosing MPE were 58.30% and 83.30%, respectively, and the area under the curve was 0.72. Pleural levels of CEA and CYFRA 21-1 were also higher in MPE. Using the combination of CTLA-4, CEA and CYFRA 21-1 increased diagnostic sensitivity to 88.89% and the area under the curve to 0.92.Conclusion: The results of this preliminary study suggest that increased levels of CTLA-4 correlate with MPE, and that CTLA-4 may have some diagnostic usefulness when used in combination with conventional tumor markers such as CEA and CYFRA 21-1. These results justify larger, more rigorous studies to validate our findings.

Study objectiveTo evaluate the diagnostic value of four different tumor markers: cancer antigen 125 (CA-125), carcinoembryonic antigen (CEA), cytokeratin 19 fragment (CYFRA 21-1) and neuron specific enolase (NSE) in patients with malignant and non-malignant pleural effusion.Material and methodsOne hundred and two patients with pleural effusion treated in the University Hospital in Warsaw between 2001 and 2003 were studied. They underwent an extensive, diagnostic work-up in order to determine the pleural effusion etiology. Patients with known pleural fluid etiology were labeled as the study group and submitted for further analysis. Pleural fluid and serum samples for CA-125, CEA, CYFRA 21-1 and NSE measurements were collected during the first thoracentesis, centrifuged, and frozen until further use. Pleural fluid and serum concentration of tumor markers were assessed by electrochemiluminescence methods using commercial kits.Results74 patients (32 M, 42 F; mean age 65 ± 14 years) composed the final study group. Exudative pleural effusion was found in 62 patients; of these 36 were malignant (48.6% of all effusions), 20 parapneumonic (or pleural empyema), and 6 tuberculous. In 12 patients, pleural transudate was diagnosed. The highest diagnostic sensitivity for malignant pleural effusion was found for NSE (94.4% and 80.6% in the pleural fluid and serum, respectively). However, the specificity of NSE measurement was relatively low (36.1% and 47.4% in pleural fluid and serum, respectively). The most specific markers of malignant pleural fluid etiology were pleural fluid CYFRA 21-1 and CEA levels (92.1% and 92.1%, respectively). CA-125 was found to be the most specific serum marker of pleural malignancies (78.9%). The AUC for combined pleural markers was 0.89, combined serum markers 0.82, combined ratio pleural/serum markers 0.88.ConclusionsThere are significant differences between the diagnostic value of various pleural fluid and serum markers. Overall, pleural fluid markers are superior to serum markers in determining the pleural fluid etiology. A combination of two or more tumor markers may help improve their diagnostic accuracy. Pleural fluid and serum measurements of different tumor markers play a limited role in the differentiation between malignant and non-malignant pleural effusions.

To investigate the clinical efficacy of heat-sensitive moxibustion combined with intrapleural perfusion of cisplatin in comparison with simple intrapleural perfusion of cisplatin on malignant pleural effusion (MPE). Forty patients with MPE, in compliance with the inclusion criteria, were randomly divided into an observation group (20 cases) and a control group (20 cases). In the control group, cisplatin solution (60 mg/m2) was injected into the thoracic cavity after pleural drainage under B-ultrasound positioning, once a week for 4 weeks. In the observation group, based on the intervention as the control group, the heat-sensitive moxibustion was delivered at the back and lumbar region (where Feishu ［BL13］, Pishu ［BL20］ and Shenshu ［BL23］ are located) and the chest-abdomen region (where Danzhong ［CV17］, Guanyuan ［CV4］ and Shuidao ［ST28］ are located), for 30 min to 90 min, once daily (the treatment was discontinued on Saturday and Sunday) and for 4 weeks. Before and after treatment, in the two groups, the pleural effusion volume was detected using B ultrasound, the activity of daily living was evaluated with Karnofsky performance statue (KPS) scale and TCM symptoms with TCM syndrome grading scale. The clinical therapeutic effect was evaluated in the two groups. According to the classification criteria table for acute and subacute toxicity of anticancer drugs made by WHO, the toxic and side reaction was judged. After treatment, the pleural effusion volume was reduced in comparison with that before treatment in the two groups (P<0.01, P<0.001), and the volume in the observation group was lower than that of the control group (P<0.05). KPS score was increased in the two groups after treatment compared with that before treatment (P<0.001), and the score in the observation group was higher than that of the control group (P<0.05). After treatment, the total score of TCM syndromes and the scores for dyspnea, cough and chest pain were lower than those before treatment in the two groups (P<0.001), and the scores in the observation group were lower than those of the control group (P<0.001, P<0.05). The scores for anorexia and lassitude were reduced in comparison with those before treatment in the observation group (P<0.001)；and the scores in the observation group were lower than those in the control group after treatment (P<0.001, P<0.01). After treatment, the effective rate of the observation group was 65.0%(13/20), which was higher than that of the control group (30.0%, 6/20, P<0.05). The incidence of bone marrow suppression in the observation group was 15.0%(3/20), lower than that in the control group (55.0%, 11/20, P<0.05). The incidence of gastrointestinal reactions in the observation group was 30.0%, lower than that in the control group (65.0%, 13/20, P<0.05). Heat-sensitive moxibustion combined with intrapleural infusion of cisplatin is superior to intrapleural infusion of cisplatin in the aspects of the amelioration of pleural effusion, daily-living activity and TCM syndromes in patients with MPE. This combined therapy presents the synergism by cooperating with chemotherapeutics and reduces the incidence of toxic and side effects implicated in chemotherapy so as to attenuate the toxicity of chemotherapeutics.

Carcinoembryonic antigen (CEA) is a tumor marker for detecting recurrences of adenocarcinomas such as colon cancer. In lung adenocarcinoma, CEA elevation can be found in both serum and malignant pleural effusion. However, CEA elevation in cytologically negative pleural effusion in the presence of adenocarcinoma without pleural infiltration has not been described. We here present the case of an 82-year-old man with incidental early stage adenocarcinoma of the right upper lobe showing CEA elevation in pleural fluid and serum despite negative cytological findings. Due to limited lung reserve the tumor was removed by wide wedge resection, but the visceral pleura was not affected and infiltration of the parietal pleura was ruled out by pleural biopsies. Serum and pleural CEA levels declined postoperatively as measured at 1 and 2 months follow-up. This case shows CEA elevation in serum and pleural fluid in early stage lung adenocarcinoma with negative cytology and no sign of pleural infiltration. Previous research revealed that CEA level in pleural effusion correlates to serum CEA and is significantly higher in adenocarcinoma of the lung than in other lung cancer entities. Firstly, this case suggests that determination of CEA levels can increase the diagnostic sensitivity in cases with cytologically negative pleural effusion suspicious of malignant origin and secondly, it contributes valuable information to the decision whether follow-up of pulmonary nodules or continuative diagnostics such as video-assisted thoracoscopic surgery (VATS) wedge resection is indicated.