Diagnostic usefulness of tumour marker levels in pleural effusions of malignant and benign origin

Pleural effusion is a common diagnostic problem. The analysis of serum and body fluids for tumor markers has been intensively applied to clinical diagnosis. The aim of the present study was to determine the usefulness of simultaneous quantification of carbohydrate antigen 19.9, carbohydrate antigen 125, neuron specific enolase, mucinous-carcinoma-associated antigen, and ferritin in samples of pleural fluids in the malign pleural effusion and its differentiation from benign effusions. A total of 61 pleural effusions were collected from the patients, who were subjected either to simple needle aspiration or to tube drainage for the diagnosis of pleural effusion. Tumor markers were determined in benign patient groups with nonspecific pleurisy, tuberculous pleurisy, empyema, congestive heart failure and in malignancy groups consisting of adenocarcinoma, small cell lung carcinoma, mesothelioma, epidermoid lung cancer. The tumor markers CA-19.9, CA-125, NSE, and ferritin levels were quantified by the sandwich assay using the streptavidin technology of ELISA in an ES-300 Boehringer-Mannheim analyser. MCA was measured by employing a two-side solid phase EIA method. MCA measurements were done by the Cobas-Core. For all patients, the effusions correctly or incorrectly identified by the different procedures as being malignant or nonmalignant are defined as true positive, false positive, true negative, and false negative, the term ‘positive’ referring to histologically proven malignant pleural effusion while nonmalignant effusions are referred to as ‘negative’. Therefore, sensitivity, specificity, positive predictive value, and negative predictive value were defined as diagnostic parameters. The cut-off values calculated were 352 U/ml for CA-125, 54 U/ml for CA-19.9, 555 for ferritin, 11.1 for MCA and 8.7 for NSE. In our study, the highest sensitivity is found to be MCA with 100%; specificity, CA-19.9 with 97%; PPV, CA-19.9 and MCA with 95% and NPV, MCA with 100%. Our data imply that the co-measurement of MCA+CA-19.9+CA-125 levels may further improve their diagnostic value in malignant pleural effusion compared with that of each tumour marker alone and may be useful in distinguishing malignant from benign pleural effusions.     

肿瘤标志物在鉴别伴有胸水的良恶性肺部疾病中的应用价值

目的:通过对胸水和血清中糖类抗原125(CA125)、糖类抗原19-9(CA19-9)、癌胚抗原(CEA)、鳞癌抗原(SCC)、神经特异性烯醇化酶(NSE)和细胞角蛋白19片段(CYFRA21-1)的检测及胸水脱落细胞学检查,探讨各指标在对伴胸水的肺部良、恶性疾病鉴别诊断中的价值。方法:应用化学发光微粒子免疫测定法和电化学发光免疫测定法对26例肺癌患者、41例良性肺部疾病患者的胸水和血清标本及30名正常体检者的血清标本进行6种肿瘤标志物测定,同时对患者胸水标本进行脱落细胞学检查,并根据受试者工作特性(ROC)曲线建立合理的临床判断临界值。结果:胸水CEA及血清CYFRA21-1对肺癌的辅助诊断价值最高。CEA含量在胸水与血清中的比值(P/S)与其他5种肿瘤标志物P/S值相比其辅助诊断价值最高。胸水标本脱落细胞学检查的灵敏度和特异度分别为69.23%和100%;而其与胸水CEA联合检测后灵敏度和特异度分别为100%和97.56%。结论:检测胸水CEA、血清CYFRA21-1对鉴别良、恶性肺部疾病有重要价值,胸水CEA与脱落细胞学联合检测可提高辅助诊断的灵敏度。     

Differentiating between malignant and idiopathic pleural effusions: the value of diagnostic procedures

BACKGROUND: Which diagnostic procedures should be used to differentiate between idiopathic and malignant pleural effusions, is not well established. AIM: To identify which parameters allow differentiation between idiopathic and malignant pleural effusions. DESIGN: Case-note review. METHODS: Over a 12-year period, we treated 1014 consecutive pleural effusion patients, of whom 346 were diagnosed as having an idiopathic or malignant aetiology. We analysed medical history, chest X-ray, pleural fluid analysis (biochemical, microbiological and cytological), chest CT scan and additional examinations that were used according to clinical findings, and compared them with the eventual diagnosis and outcome. RESULTS: Eighty-three patients with idiopathic effusions and 263 with malignant effusions were included. Idiopathic pleural effusion resolved in 47 patients, improved in 20 and persisted in 16. Biochemical pleural fluid analysis did not predict these outcomes. A history of neoplasm, chest X-ray and CT features, as well as additional examinations according to clinical findings, established a diagnosis or suspicion of malignancy in 256 (97.7%) of the 263 patients who received a diagnosis of malignant effusion. Diagnostic thoracoscopy was helpful in seven patients in whom malignant disease was strongly suspected, despite the absence of other pathological findings. DISCUSSION: Non-invasive complementary examinations generally allowed accurate differentiation between malignant and idiopathic effusions. Patients with idiopathic pleural effusions generally had favourable outcomes.     

CD44v6、CEA检测在癌性胸水患者中的临床应用

目的探讨CD44v6和CEA在胸腔积液性质鉴别诊断中的应用价值。方法选取65名胸腔积液患者,35例为恶性胸腔积液,30例为良性胸腔积液。抽取胸腔积液后采用ELISA法厦化学发光方法检测CD44v6、CEA的含量。结果恶性胸腔积液中的CD44v6、CEA水平明显高于良性胸腔积液,差异有统计学意义。CD44v6的恶性胸腔积液诊断分界点为15．60ng／ml,敏感性为88．60％,特异性为80．00％。CEA的恶性胸腔积液诊断分界点为1．15ng／ml,敏感性为68．60％,特异性为63．30％。CD44v6＋CEA联合检测的敏感性为88．60％,特异性为86．70％。结论CD44v6、CEA检测对良、恶性胸腔积液的鉴别诊断有一定的临床意义。两者联合检测可提高诊断的特异性。     

Diagnostic value of the combined determination of carcinoembryonic antigen (CEA) in pleural effusion and serum with an enzyme immunoassay (EIA). Sensitivity, specificity and relation to tumor type

Measurement of carcinoembryonal (CEA) levels in pleural fluid are suggested to improve the unsatisfactory sensitivity of pleural cytology in the differential diagnosis of malignant pleural effusions. We evaluated simultaneously determined pleural and serum CEA levels in 117 patients with pleural effusions of different aetiology (74 malignant, 30 inflammatory exudates and 13 transudates) by use of an enzyme immunoassay (EIA). Despite considerable scatter, pleural levels of CEA in malignant effusions were significantly higher (p less than 0.001) than the values in benign effusions. Using a cut off level of 5 ng/ml, 41% (= sensitivity) of malignant pleural effusions showed elevated concentrations of CEA. Only one out of 43 benign effusions showed a level of 5 ng/ml, which is equivalent to a specificity of 98%. However, malignant effusions due to small cell lung cancer, pleural mesothelioma and metastasising ovarian carcinoma never showed elevated levels of CEA. Highest pleural values of CEA were observed in cases of alveolar cell or adenocarcinoma of the lung or metastasising breast cancer. Although pleural and serum CEA levels correlated significantly (rs = 0.77), the evaluation of serum CEA levels alone yielded a lower sensitivity (36%) and specificity (93%) than pleural levels. 77% of cases with malignant pleural effusions showing elevated pleural CEA levels were characterized by an increased ratio Pleura/Serum greater than 1, particularly in effusions due to lung cancer. The CEA ratio was significantly higher (p less than 0.05) in patients with malignant than with benign effusions. EIA appears to be more specific by avoiding false positive results in benign effusions as compared with determination by conventional RIA. In conclusion, evaluation of pleural CEA levels in patients with malignant effusions by using an EIA because of its high specificity is a valuable adjunct to pleural cytology in improving the diagnosis of malignant effusions. However, a normal CEA level in either pleural effusion or in serum is of no clinical significance. Simultaneous measurement in pleural effusion and serum is of greater value.     

Clinical value of CYFRA21-1, NSE, CA15-3, CA19-9 and CA125 assay in the elderly patients with pleural effusions

The aim of this study was to evaluate the individual and combined diagnostic value of five tumour markers in the elderly patients with pleural effusions. Serum and pleural fluid levels of cytokeratin fragment 19 (CYFRA21-1), neuron-specific enolase (NSE), carbohydrate antigen 15-3 (CA15-3), carbohydrate antigen 19-9 (CA19-9) and carbohydrate antigen 125 (CA125) were assayed in 32 elderly patients with malignant pleural effusions resulting from advanced lung cancer and in 30 elderly patients with benign pleural effusions by ELISA. Serum levels of CYFRA21-1, NSE, CA15-3, CA19-9 and CA125 in patients with malignant pleural effusions were 12.84 +/- 6.48 microg/l, 22.07 +/- 11.25 microg/l, 65.74 +/- 30.26 kU/l, 56.32 +/- 25.6 kU/l and 71.86 +/- 31.45 kU/l, respectively, and were significantly higher than those in patients with benign pleural effusions (p < 0.01). Pleural fluid levels of CYFRA21-1, CA15-3, CA19-9 and CA125 except NSE in patients with malignant pleural effusions were 18.64 +/- 8.15 microg/l, 59.31 +/- 27.35 kU/l, 48.24 +/- 21.56 kU/l and 62.16 +/- 27.79 kU/l, respectively, and were significantly higher than those in patients with benign pleural effusions (p < 0.01). The parallel combined testing of five tumour markers in serum increased the diagnostic sensitivity to 90.6%, and serial combined testing increased the diagnostic specificity to 93.3%. The sensitivity (%) and specificity (%) of these tumour markers in pleural fluid were as follows: CYFRA21-1, 84.4/90; CA15-3, 62.5/73.3; CA19-9, 37.5/66.7; CA125, 56.3/70; for differentiating malignant effusions from benign effusions. When CYFRA21-1 and CA15-3 combined, the sensitivity and specificity were increased (100% and 90% respectively). Serum and pleural fluid levels of the five tumour markers shows certain values in the diagnosis and differentiate diagnosis for malignant pleural effusions in the elderly patients from benign. The combined assay of five tumour markers in serum and the CYFRA21-1 combined with CA15-3 in pleural fluid were helpful and can increase the sensitivity and specificity in diagnosing malignant pleural effusions.     

Differentiating transudative from exudative pleural effusion: should we measure effusion cholesterol dehydrogenase?

INTRODUCTION: Pleural effusions are often classified into transudates and exudates based on Light's criteria. In this study, the diagnostic properties of Light's criteria were compared to those of several other analytes for the classification of pleural fluids into transudative and exudative. METHODS: A total of 471 patients with pleural effusions were evaluated. In pleural effusions and simultaneously drawn blood samples, lactate dehydrogenase (LDH), total protein, albumin, cholesterol, amylase, glucose, pH and the cell number were measured. Retrospectively, the clinical records were used to establish a clinical diagnosis. The diagnostic properties of the biochemical tests were calculated using the clinical diagnoses as gold standard. RESULTS: By clinical diagnosis, 108 patients had transudative and 300 patients had exudative pleural effusions. In addition to pleural LDH activity (accuracy 89%, sensitivity 86%, specificity 97%) and fluid to serum LDH ratio (accuracy 89%, sensitivity 91%, specificity 85%), pleural cholesterol concentration readily identified exudates (accuracy 82%, sensitivity 76%, specificity 98%). Combination of these three parameters achieved a higher overall accuracy (accuracy 95%, sensitivity 93%, specificity 100%) than the Light's criteria (accuracy 93%, sensitivity 100%, specificity 73%). Combination of effusion cholesterol concentration and effusion LDH activity had the highest discriminatory potential (accuracy 98%, sensitivity 98%, specificity 95%). CONCLUSIONS: Including effusion cholesterol, concentration in the routine biochemical work-up of pleural fluid allows for correct classification of more pleural effusions than achieved by use of Light's criteria. Combination of cholesterol and LDH had the highest discriminatory potential and the added advantage that no patient plasma is needed for correct classification.     

胸水中CYFRA21－1测定的临床意义

利用ＢｏｅｈｒｉｎｇｅｒＭａｎｎｈｅｉｍ公司的ＣＹＦＲＡ２１－１酶免疫分析试剂盒，测定了已有明确诊断的１３０例胸腔渗漏液标本。结果表明，ＣＹＦＲＡ２１－１对于癌性胸水的诊断敏感性为６１．３％，特异性为８７．３％，准确度为７２．３％。若同时利用ＡＤＡ活性测定排除结核性胸膜炎，则其特异性可达９２．８％。揭示ＣＹＦＲＡ２１－１测定对胸水良恶性的诊断与鉴别诊断具有重要的临床价值。     

Quantitative analysis of pleural fluid cell-free DNA as a tool for the classification of pleural effusions

BACKGROUND: Recently, much interest has been focused on the quantification of DNA in miscellaneous body fluids. In this study, the application is extended to classifying pleural effusions by measuring cell-free DNA in pleural fluid. METHODS: We recruited 50 consecutive patients with pleural effusions with informed consent. Pleural fluids were centrifuged at 13000 g, with supernatants aliquoted for extraction and analysis of beta-globin DNA sequence by quantitative real-time PCR. Serum and pleural fluid biochemistries were performed to classify pleural effusions using the modified criteria of Light et al. (Ann Intern Med 1972;77:507-13). The ROC curve was plotted to determine the cutoff DNA concentration for classifying pleural fluids as transudates or exudates. Indicators of diagnostic accuracy were calculated for both pleural fluid DNA and modified criteria of Light et al., using the discharge, microbiologic, and histologic diagnoses as the reference standard. RESULTS: The area under the ROC curve was 0.95 [95% confidence interval (CI), 0.84-0.99]. At 509 genome-equivalents/mL, pleural fluid DNA alone correctly classified 46 of 50 pleural effusions with 91% sensitivity (95% CI, 76-98%), 88% specificity (95% CI, 64-98%), and positive and negative likelihood ratios of 7.7 (95% CI, 3.1-19.5) and 0.10 (95% CI, 0.04-0.27), respectively. With the modified criteria of Light et al., 43 of 50 pleural effusions were correctly classified with 97% sensitivity (95% CI, 91-100%) and 67% specificity (95% CI, 45-89%). There were significant correlations between cell-free DNA and both lactate dehydrogenase and total protein in pleural fluid, suggesting their common origin. CONCLUSIONS: Pleural fluid DNA concentrations are markedly increased in exudative effusions, making it a potential new tool to evaluate the etiologic causes of pleural effusions.     

Tumour necrosis factor alpha in the diagnostic assessment of pleural effusion

We investigated the role of tumour necrosis factor-alpha (TNF) in the evaluation of pleural effusion aetiology. Using a commercially-available ELISA kit, concentrations of TNF were measured in the serum and pleural fluid of patients with malignant effusions (n=19), uncomplicated parapneumonic effusions (n=13), and exudative (n=13) and transudative (n=13) effusions due to congestive heart failure (CHFex and CHFtr, respectively). Serum TNF did not differ significantly between the four groups (p>0.05). In the group with malignancy, pleural fluid TNF was significantly higher than in the other groups (p<0.001), which were not significant different from each other (p>0.05). However, a considerable overlap between all four groups was found. Pleural fluid TNF was significantly higher than serum TNF in the malignant and the uncomplicated parapneumonic groups (p<0.001), and there was a significant positive correlation between serum TNF and pleural fluid TNF in the group with uncomplicated parapneumonic effusion (r=0.7, p<0.005), in the group with CHFex (r=0.54, p<0.01), and in the group with CHFtr (r=0. 8, p<0.005), but not in the group with malignancy. Pleural fluid TNF:serum TNF (TNF ratio) was significantly higher in the malignancy group than in the other groups (p<0.001); no significant difference was found between the other three groups (p>0.05). At an optimal cut-off point of 2.0 for TNF ratio, determined by ROC analysis for discrimination between malignant and non-malignant groups, sensitivity was 84%, specificity 90%, and total accuracy 88% (p<0. 0001). TNF ratio might be helpful in the diagnostic assessment of exudative pleural effusion.     

胸水细胞p53和K-ras基因突变对于肺癌的诊断价值

目的：研究p53和K-ras基因在良恶性胸水细胞中的突变情况。方法 研究组为34例伴有恶性胸水的肺癌患者，对照组为28例出现胸水的结核性胸膜炎和其他炎性胸膜炎患者。常规抽水胸水，提取胸水细胞DNA，采用PCR-SSCP方法，分别对p53基因第7、8外显子和K-raS基因第1、2外显子进行突变分析。结果 研究组p53基因突变率为41．2％，而对照组只有7．1％，明显低于肺癌患者（P〈0．05）；研究组K-ras基因突变率（32．4％）也明显高于对照组（3．6％）（P〈0．05）。联合应用p53和K-ras基因突变检测可将胸水细胞中肺癌阳性检出率提高至61．8％。结论 p53和K-ras基因突变是良恶性胸水鉴别诊断的潜在生物学指标。     

胸腹水细胞学与组织学制片的免疫细胞化学诊断对比研究

目的探讨脱落细胞学与组织病理学制片在胸腹水恶性细胞诊断中的敏感性。方法103例患者胸腹水标本经特殊处理后，分别做细胞学涂片和石蜡包埋制片，并采用免疫细胞化学（ICC）方法，用肿瘤相关糖蛋白72和癌胚抗原组合、神经特异性钙结合蛋白和血栓素组合进行诊断，比较其阳性检出率。结果石蜡包埋制片肿瘤相关糖蛋白72和癌胚抗原组合、神经特异性钙结合蛋白和血栓素组合分别诊断转移腺癌阳性率97．9％、恶性间皮瘤阳性率100％；应用相应抗体组合，细胞学涂片的阳性率分别为95．8％。100％。两者阳性率比较无显著性差异（x^2=0．17，P〉0．05）。结论通过对胸、腹水标本和材料的前期有效处理后，细胞学涂片的免疫细胞化学诊断转移性腺癌、恶性间皮瘤的敏感性与组织学方法具有较高的一致性。     

An inhibitor of tumor necrosis factor found in pleural effusions

Tumor necrosis factor (TNF) has significant biologic effects. Inhibitors of TNF have been isolated from urine and blood. We studied pleural fluid from 22 patients with benign or malignant effusions. Pleural macrophages from these effusions were capable of releasing TNF, especially when stimulated with lipopolysaccharide. The cell-free supernatant from some of these pleural effusions contained an inhibitor of TNF. Fluid from 12 malignant effusions contained an inhibitor of 17% +/- 15.4% (mean +/- SD) of 500 U/ml of TNF activity, whereas the mean inhibition in 10 benign effusions was 2% +/- 5.6% (p less than 0.05). Only one of 10 benign effusions had more than 10% inhibitory activity. This inhibitor was found to be heat sensitive and unaffected by dialysis, and the molecular weight of at least one of the inhibitors was 60 to 80,000 daltons. Enzyme digestion studies were consistent with a protein portion being the major determinant of activity. We conclude that some malignant effusions contain an inhibitor of TNF activity.     

Diagnostic value of uric acid to differentiate transudates and exudates.

Uric acid is known to be an end product of purine metabolism. Increases in uric acid may be found in clinical conditions associated with tissue hypoxia. We have investigated the value of uric acid to differentiate between a transudate and exudate. In this study, we measured uric acid in the pleural fluid and the serum of 110 patients, 30 women and 80 men with a mean age of 49.5+/-19 years. Light's criteria were used to differentiate between a transudate and exudate. Mean serum uric acid was 496.7+/-153.4 micromol/l in patients with transudates and 291.3+/-143.1 micromol/l in patients with exudates. Mean pleural fluid uric acid was 487.7+/-165 micromol/l in patients with transudates and 279.9+/-142.1 micromol/l in patients with exudates. These data showed that the levels of serum and pleural uric acid were higher in transudates than exudates (p<0.01). However, there was no significant difference between pleural fluid/serum uric acid ratio of the two patient groups (p>0.05). The specificity and sensitivity of pleural uric acid for diagnosis of transudate effusions were 73% and 80.6%, respectively. The specificity and sensitivity of pleural uric acid for diagnosis of transudate effusions from exudates without malignancy were 71.8% and 91.7%, respectively. The sensitivity and specificity of pleural lactate dehydrogenase for diagnosis of exudates were 82% and 89%; the sensitivity and specificity of pleural fluid/serum lactate dehydrogenase were 85% and 89%; the sensitivity and specificity of pleural fluid/serum protein were 91% and 89%, respectively. Using all three of Light's criteria together, the sensitivity was 91% and its specificity was 94%. Our findings indicate that determination of uric acid in pleural fluid may be of diagnostic value in differential diagnosis of transudates and exudates. The sensitivity of pleural uric acid measurement was higher for exudates without malignancy. However, Light's criteria remain the best means of separating transudates from exudates.     

内科胸腔镜胸膜活检术与血清肿瘤标志物在不明原因胸腔积液中的诊断价值*

目的探讨内科胸腔镜下胸膜活检术和肺部肿瘤标志物对不明原因胸腔积液的临床应用价值。方法回顾性分析该院2014年1月-2016年3月76例不明原因胸腔积液的患者,采用内科胸腔镜进行胸膜活检送病理,且在入院时即采集患者静脉血10 ml送检,查血清肿瘤标志物[癌胚抗原(CEA)、鳞状细胞癌抗原(SCC-Ag)、胃泌素释放肽前体(Pro GRP)、细胞角蛋白19片段(CYFRA21-1)]进行测定。结果 76例不明原因胸腔积液的患者中有良性病变32例(肺结核14例,炎性病变9例,肉芽肿性炎6例,脓胸2例,错构瘤1例);恶性病变44例(腺癌18例,鳞癌13例,小细胞肺癌6例,腺鳞癌3例,间皮瘤2例,大细胞癌1例,胸腺瘤1例)。检测血清肿瘤标志物发现,血清中CEA、SCC-Ag、Pro GRP、CYFRA21-1水平在恶性胸腔积液组与良性胸腔积液组之间差异具有统计学意义(P=0.021、P=0.006、P=0.003和P=0.010),恶性胸腔积液患者血清各项肿瘤标记物水平明显高于良性胸腔积液的患者。根据病理结果将44例恶性胸腔积液中非肺癌所致胸腔积液的患者剔除(即2例间皮瘤及1例胸腺瘤患者),将剩下的41例肺癌所致胸腔积液患者,根据病理类型分为非小细胞肺癌(NSCLC)与小细胞肺癌(SCLC)。分析结果显示CEA、Pro GRP和CYFRA21-1水平在NSCLC与SCLC中差异具有统计学意义(P=0.036,P=0.005,P=0.008),而SCC-Ag差异无统计学意义(P=0.811)。结论内科胸腔镜在不明原因胸腔积液中具有检出率高、准确性高的特点,尤其是对胸膜转移瘤的恶性胸积液的诊断具有重要的意义。但血清学指标可以在病理结果出来之前为医师提供重要的参考价值,是临床诊断肺癌所致恶性胸腔积液的一种重要的手段,值得在临床推广应用。     

染色体检查在恶性胸腔积液诊断中的价值

目的探讨染色体检查在胸腔积液鉴别诊断中的价值。方法采用常规染色体定性检查和流式细胞术(FCM)DNA定量分析两种方法检查胸腔积液中的染色体，并进行比较。结果常规染色体检查对恶性胸腔积液诊断的特异性为98．2％，敏感性为88．9％；FCM法特异性为100％，敏感性为93．8％；二者联合的特异性为100％，敏感性为86．4％。结论常规染色体检查和FCM DNA定量分析两种方法联合检查对胸腔积液的鉴别诊断提供了可靠的诊断依据。     

Pleural fluid ADA, IgA-ELISA and PCR sensitivities for the diagnosis of pleural tuberculosis

The diagnosis of pleural tuberculosis (pTB) is difficult, and more sensitive and specific techniques are needed. In the period August 1998 to November 2002, we evaluated 132 patients with a pleural effusion submitted to a thoracentesis and pleural biopsy in a tertiary care hospital in Rio de Janeiro, Brazil. Three tests were performed and compared in the pleural fluid: ADA activity measurement, IgA-ELISA for two combined specific Mycobacterium tuberculosis antigens, and polymerase chain reaction (PCR) for detection of M. tuberculosis DNA. Ninety-five patients (72%) were given a final diagnosis of pTB. Overall histopathologic sensitivity was 77%. The sensitivities of pleural fluid culture and AFB smear were 42% and 1%, respectively. Twenty-one (22%) additional patients had a clinical diagnosis of pTB. Median follow-up time of all TB patients after the completion of antituberculous treatment was 13 months. Sensitivities of ADA, IgA-ELISA and PCR were 91%, 78% and 82%, while specificities were 93%, 96% and 85%, respectively. Only ADA sensitivity was significantly higher than the histopathologic examination (McNemar chi2 test; p = 0.002) and also significantly higher than ELISA (p = 0.049), but not higher than PCR (p = 0.143). We conclude that the routine use of ADA activity measurement in pleural fluid can obviate the need for a pleural biopsy in the initial diagnostic approach to pleural effusions, while IgA-ELISA and PCR techniques, potentially more specific tests, need further refinement to improve their accuracy.     

AgNOR和染色体检查在胸腔积液诊断中的价值

目的：探讨核仁组成区嗜银蛋白（AgNOR）定量检测与染色体检查在良、恶性胸腔积液鉴别诊断中的价值。方法：C地50例良性、30例恶性胸腔积液患的胸水涂片进行银染,用AgNOR技术进行检测（由图像处理系统检测细胞核面积,胞核周长,胞核直径,形状因子、核仁总数目、核总面积、核仁面积、核仁面积和面积比）;胸水直接涂片和短期细胞培养两种方法进行染色体检查,以比较良、恶性胸腔积液之间的差异。结果：恶性胸腔积液组AgNOR各项指标与良性组比较均有显性差异（P＜0．01）,其染色体以超二倍体为主,多数为非整倍体,其敏感为86．75,特异性为82％,结论AgNOR在良,恶性胸腔积液诊断中为一有效的临床指标,结合染色体检查更有助于鉴别诊断。     

Soluble oncoprotein 185HER-2 in pleural fluid has limited usefulness for the diagnostic evaluation of malignant effusions

OBJECTIVES: To investigate whether pleural levels of the soluble oncoprotein 185 HER-2 (sp185(HER-2)), individually or in combination with CEA and CA 15-3, were useful for the diagnosis of malignant effusions. DESIGN AND METHODS: Levels of CEA, CA 15-3, and sp185(HER-2) were measured in the pleural fluid from 135 malignant and 103 benign effusions. Thresholds of these tumor markers were chosen for a diagnostic specificity of >or=99%. RESULTS: Pleural sp185(HER-2) levels greater than 25 ng/mL were observed in 20% of breast and 10% of lung adenocarcinomas, and predicted a malignant effusion with a sensitivity of 7% and a likelihood ratio of 7.6. Combination of CEA and CA 15-3 resulted in 50% sensitivity, while adding sp185(HER-2) to this panel nonsignificantly increased sensitivity by 5% (P = 0.45). Only 1 patient with breast adenocarcinoma among 45 cytology-negative malignant effusions had sp185(HER-2) above the diagnostic cutoff point. CONCLUSION: Measurement of pleural fluid sp185(HER-2) has poor diagnostic performance in patients with malignant effusions.