Pleural effusion: CEA helped diagnose malignancy.

Clinical bottom line (level 4)

  1. Malignancy was a common cause of pleural effusion.
  2. A raised pleural fluid CEA made malignancy more likely (LR+5.1) , but was not diagnostic.
  3. A normal CEA could not exclude malignancy (LR-0.58) .
Garcia-Pachon et al: Chest 1997; 111 (3): 643-647
Expires October 2003

The study

Setting: two university hospitals, Spain

305 patients (aged ?, ?% male) admitted with pleural effusion

Excluded if
  • incomplete follow-up



    • Independent unblinded reference standard, applied in all patients from a consecutive appropriate spectrum.
    Reference standard:
      • cytology or pleural biopsy, or known malignancy with no obvious alternative diagnosis
      • followed for 6 months if negative results
    Diagnostic test: fluid carcinoembryonic antigen: positive if > 10 ng/ml

    The evidence

    pre-test probability of malignancy: 33%, (95% CI: 28% to 39%)

    diagnostic test malignancy no malignancy LR+
    (95% CI)    		 post-test probability LR-
    (95% CI)    		 post-test probability
    CEA positive 43 17 5.1
    (3.1 to 8.4)     		72% 0.58
    (0.48 to 0.71)     		23%
    total 91 182

    Comments

    1. Results are similar to other studies.

    Citation

    1. Garcia-Pachon E, Padilla-Navas I, Dosda D, et al: elevated level of carcinoembryonic antigen in nonmalignant pleural effusions. Chest 1997; 111 (3): 643-647
    Contributor: Chris Ball and Clare Wotton, October 2000
    Reviewer:

    Clinical Question.
    Patient pleural effusion
    Intervention or Exposure pleural fluid CEA
    Outcome malignancy