Pleural effusion: malignancy: greatly-elevated tumour markers were diagnostic.

Clinical bottom line (level 4)

  1. Greatly elevated tumour markers diagnosed malignancy in patients with pleural effusions.
  2. Tumour markers could not safely exclude malignancy.
Villena et al: Cancer 1996; 78: 736-740
Expires October 2003

The study

Setting: acute hospital, Spain

207 patients (aged range 15 to 90 years; mean 54, 67% male) pleural effusion

Excluded if
  • known malignancy with para malignant aetiology of effusion could not be rejected



    • Independent unblinded reference standard, applied in all patients from a consecutive appropriate spectrum.
    Reference standard:
      • positive cytology or histology of neoplasm in pleural space
      • if negative and no other clear cause found, followed for six months
    Diagnostic test: pleural fluid:
    • CA 72-4 > 8.9 U/ml
    • CEA > 40 ng/ml
    • CA 15-3 > 42 U/ml
    • CA 19-9 > 580 U/ml

    The evidence

    pre-test probability of malignancy: 31%, (95% CI: 25% to 38%)

    diagnostic test malignancy no malignancy LR+
    (95% CI)    		 post-test probability LR-
    (95% CI)    		 post-test probability
    CA 72-4 33 3 24
    (7.7 to 76)     		92% 0.50
    (0.39 to 0.64)     		19%
    CEA 28 0 inf
    (21 to inf)     		100% 0.57
    (0.46 to 0.70)     		21%
    CA 15-3 36 4 20
    (7.3 to 53)     		90% 0.46
    (0.35 to 0.60)     		17%
    CA 19-9 13 0 inf
    (9.6 to inf)     		100% 0.80
    (0.71 to 0.90)     		27%
    total 65 142

    Comments

    1. Note higher cut-off point used for CEA than most other studies.

    Citation

    1. Villena V, Lopez-Encuentra A, Echave-Sustaeta J, et al: diagnostic value of CA 72-4, carcinoembryonic antigen, CA 15-3 and CA 19-9 assay in pleural fluid. Cancer 1996; 78: 736-740
    Contributor: Chris Ball and Clare Wotton, October 2000
    Reviewer:

    Clinical Question.
    Patient pleural effusion
    Intervention or Exposure elevated tumour markers
    Outcome diagnosis of malignancy