[ role of pleural fluid glucose level in differentiating between intra- and extra-thoracic tumors]

To evaluate the value of depending on pleural fluid glucose level of less than 40 mg/dl for differentiating whether malignant pleural effusion is due to intrathoracic or extrathoracic tumors. This is a retrospective cross-sectional study in which a total of 69 patients, admitted to our hospital, having malignant pleural effusion due to varying malignancies, were included in this study. According to the final diagnosis, these 69 patients were divided into two groups: intrathoracic tumors [23 patients], and extrathoracic tumors [46 patients]. Chi-square was applied and p-value and confidence intervals were obtained. Sensitivity, specificity and accuracy values were calculated. Glucose level of lower than 40 mg/dl was observed in 8 out of 23 cases of intrathoracic tumors. None of 46 cases of extrathoracic tumors had a value of pleural fluid glucose of less than 40 mg/dl. Accordingly sensitivity, specificity and accuracy values were 35%, 100% and 67% respectively for a cut-off value of 40 mg/dl for pleural glucose. From this study, it is concluded that pleural fluid glucose is a useful test in helping to differentiate the origin of pleural effusion whether it is due to intrathoracic or extrathoracic tumors

Avaliação dos valores sérico e pleural dos marcadores tumorais CEA, CYFRA21-1 e CA 15-3 em portadores de derrame pleural / Evaluation of serum and pleural levels of the tumor markers CEA, CYFRA21-1 and CA 15-3 in patients with pleural effusion

OBJETIVO: Dosar os marcadores tumorais antígeno carcinoembrionário (CEA), fragmento da citoqueratina 19 (CYFRA21-1) e antígeno glicosídico associado a tumor 15-3 (CA 15-3) em sangue e líquido pleural de portadores de derrames pleurais benignos e malignos, avaliando a sensibilidade de cada um deles nesses fluidos. MÉTODOS: Avaliamos prospectivamente 85 pacientes com derrame pleural. O estudo do líquido pleural obedeceu a critérios determinados pela literatura. A dosagem dos marcadores foi realizada por eletroquimioluminescência. A sensibilidade foi determinada sob a condição de que a especificidade fosse > 90 por cento. RESULTADOS: Foram diagnosticados 36 casos malignos (42,4 por cento), 30 benignos (35,3 por cento); em 19 pacientes (22,3 por cento), o diagnóstico foi inconclusivo. Nos casos malignos, os valores de CEA e CYFRA21-1 foram maiores no líquido pleural do que no sangue, fato não observado para o CA 15-3. Nos casos benignos, os valores do CYFRA21-1 foram maiores no líquido pleural do que no soro, enquanto que para o CEA e o CA 15-3, ocorreu o oposto. Todos os marcadores apresentaram diferença significativa entre os casos malignos e benignos, em líquido pleural e soro. Foi encontrada sensibilidade para CEA, CYFRA21-1 e CA 15-3 no líquido pleural de 69,4 por cento, 69,4 por cento e 66,7 por cento, respectivamente e quando associados, foi 80,6 por cento. No soro, a sensibilidade foi 57,1, 71,4 e 48,6 por cento para CEA, CYFRA21-1 e CA 15-3, respectivamente, e quando associados, foi 77 por cento. CONCLUSÃO: Os resultados sugerem que a utilização desses marcadores pode ser útil na diferenciação entre derrames pleurais malignos e benignos.

OBJECTIVE: To determine the levels of the tumor markers carcinoembryonic antigen (CEA), cytokeratin 19 fragment (CYFRA21-1) and carbohydrate antigen 15-3 (CA 15-3) in the blood and pleural fluid of patients with benign or malignant pleural effusion, evaluating the sensitivity of each marker in these fluids. METHODS: We prospectively evaluated 85 patients with pleural effusion. The study of the pleural fluid observed the criteria established in the literature. Levels of the markers were determined using electrochemiluminescence. The sensitivity was determined on the condition that the specificity was > 90 percent. RESULTS: Of the 85 cases, 36 (42.4 percent) were malignant, 30 (35.3 percent) were benign, and the results were inconclusive in 19 (22.3 percent). In the malignant cases, the CEA and CYFRA21-1 levels were higher in the pleural fluid than in the blood, which was not observed for CA 15-3. In the benign cases, the CYFRA21-1 levels were higher in the pleural fluid than in the blood, whereas the opposite was found for CEA and CA 15-3. There were significant differences between malignant and benign cases for all markers, in pleural fluid and blood. In the pleural fluid, the sensitivity of CEA, CYFRA21-1 and CA 15-3 was 69.4, 69.4 and 66.7 percent, respectively, and the combined sensitivity was 80.6 percent. In the blood, the sensitivity was 57.1 percent, 71.4 percent and 48.6 percent for CEA, CYFRA21-1 and CA 15-3, respectively, and the combined sensitivity was 77 percent. CONCLUSION: The results suggest that these markers might be useful in the differentiation between malignant and benign pleural effusion.

Utilidad del pH del líquido pleural en derrames pleurales neoplásicos / Usefulness of pleural fluid pH in neoplastic effusions

Con el objeto de evaluar la utilidad del pH pleural en pleuresías neoplásicas, se estudiaron retrospectivamente 16 casos hospitalizados en el Servicio de Medicina del Hospital Regional de Concepción. Se encontró pH plural normal (>7,30) en nueve enfermos y en 7 pH pleural bajo (< 7,30). Los casos con pH pleural bajo, resultaron con valores significativamente menores de glucosa pleural (p < 0,001), y con valores significativamente elevados de LDH pleural (p< 0,001). En relación a procedimientos diagnósticos, el rendimiento de la citología en líquido pleural para células neoplásticas fue mayor (71 por ciento), en los pacientes con pH pleural bajo. Los enfermos con ph pleural normal, fueron sometidos a pleurodesis con hidróxido de sodio y tuvieron mejor sobrevida (50 por ciento) a dos meses de observación que los no sometidos a este procedimiento (20 por ciento). En resumen, el estudio del pH pleural en derrames pleurales neoplásicos, presta utilidad como índice pronóstico, siendo al mismo tiempo indicativo para decidir una pleurodesis como terapia paliativa, puesto que la pleurodesis tiene una pobre relación costo/efecto si el pH del líquido pleural es menor de 7,30

Detection of Malignant Cells in Pleural Fluid or Ascites by CD44v8-10/CD44v10 competitive RT-PCR

BACKGROUND: CD44 is a cell surface adhesion molecule which has been implicated in various biologic functions as lymphocyte homing and activation, cellular migration and extracellular matrix adhesion. Over-expression of CD44v8- 10 has been found in several cancers and is considered to be associated with tumor progression and metastasis. Recently, a novel molecular method, CD44v8- 10/CD44v10 competitive reverse transcription-polymerase chain reaction(RT-PCR) has been developed for detecting cancer cells over-expressing CD44v8-10. METHODS: We analyzed from benign and malignant pleural effusion and ascites by CD44 competitive RT-PCR and compared to the conventional cytology. RESULTS: The CD44 competitive RT-PCR analysis showed that all the 24 samples associated with benign disease presented a predominant expression of the CD44v10 transcript (v8-10/v10 ratio: 0.126-0.948), whereas 6 of 7 malignant pleural samples associated with cytology positive cancer expressed the CD44v8-10 transcript (v8-10/v10 ratio > 1.00). CONCLUSION: These results indicate that CD44 competitive RT-PCR assay is a useful and adjunct to cytological examination in cancer diagnosis, especially in detecting exfoliated cancer cells in pleural effusion.