Utility of AgNor, immunocytochemistry for CEA and tumor markers for diagnosis in serous fluids

ABSTRACT

Objective: The evaluation of serous fluids stained by morphological methods lacks, in many cases, the necessary accuracy to obtain the correct diagnostics. The objective of this work was to establish the value of complementary tools for the improvement of diagnosis in serous effusions. Methods: Fifty-six serous effusions were processed for morphological staining, immunocytochemistry of carcinoembryonic antigen (CEA), AgNOR counting and electrochemiluminescense immunoassay for tumor markers (TM) CEA, Ca125 and CYFRA 21-1. TM assays were also performed in sera from the same patients. The Sensitivity (Se) and Specificity (Sp) were evaluated for all the methods. Results: Cytology Se 73 per cent, Sp 100 per cent, CEA by immunocytochemistry Se 96 per cent, Sp 75 per cent, AgNORSe 86 per cent, Sp100 per cent, TM a) in fluids CEA, Ca125 and CYFRA 21-1, Se 29 per cent, 66 per cent and 64 per cent respectively and Sp 100 por cento, 87 por cento and 100 por cento respectively. b) in sera CEA, Ca125 and CYFRA 21-1 Se 27 per cent, 77 per cent and 47 per cent respectively and Sp 100 per cent, 25 per cent and 75 per cent respectively. CEA (in cells) + TM (fluids) Se 100 per cent and Sp 75 per cent AgNOR + TM (fluids) Se 95 per cent and Sp 87 per cent TM Panel (CEA+Ca125+CYFRA 21-1) a) in fluids Se 81 per cent and Sp 87 per cent b) in sera Se 86 per cent and Sp 12 per cent Conclusion: AgNOR assay and immunocytochemistry for CEA were useful as complementary tools in the diagnosis using effusions, raising the Sensitivity of the Cytology from 73 per cent to 86 per cent and 96 per cent respectively. Sensitivity increased with the assays for a panel of TM in fluids, but the high costof these methods does not justify their use for non-conclusive smears.