مقایسه ارزش تشخیصی تومور مارکرهای مایع پلور با سیتولوژی مایع پلور و بیوپسی ‌پلور در اثبات وجود بدخیمی

    Introduction: Cancers are the most prevalent causes of exudative pleural effusions after para-pneumonic pleural effusions. Despite the combination of the pleural fluid cytological studies and pleural biopsy, diagnosis could not be reached in an important number of cases. In an attempt to improve the value of pleural fluid analysis in the diagnosis of malignant pleural effusion, some studies have focused on the evaluation of different tumor markers. In this study we decided to determine diagnostic value of tumor marker assay in pleural effusions versus cytology and biopsy.   Materials and Methods: This analytical cross-sectional study was performed in Hazrat-e-Rasool Akram Hospital. Forty patients with lymphocyte dominant pleural effusion and negative pleural fluid smears and cultures for tuberculosis were enrolled in this study. Cytology, biopsy and thoracoscopy (if needed) were done. Levels of the six selected tumor markers (αFP, CEA, CA 19-9, CA 15-3, CA 125 and β-hCG) were measured in the pleural fluid. Sensitivity, specificity, positive and negative predictive values were calculated regarding the results of cytology, biopsy and thoracoscopy. Also, t-test and Chi2 were used in data analyses.   Results: The sensitivity of the six measured tumor markers in pleural effusion was: 4% AFP, 52% ß-hCG, 35% CA 19-9, 65% CEA, 95% CA 125 and 65% CA 15-3. The specificity of all tumor markers was 100%, except CA 125 which was calculated as 25%. The combination of markers including CA15-3, CA 19-9, CEA and β-hCG had sensitivity and specificity of 95.6% and 100% and PPV and NPV of 100% and 80%, respectively.   Conclusion: Using tumor markers could possibly be a suitable substitute for invasive and expensive methods such as thoracoscopy and thoracotomy. It seems that applying the combination of numerous tumor markers, increases the sensitivity and helps us to make better differential diagnoses.