The Diagnosis of Metastatic Malignancy in Ascites and Pleural Effusion by Fluid Tumor Marker in Comparison to Cytology

Study objective is measurement the sensitivity of CA125,CA15-3, CA19-9, CEA, NSE, and α-FP in the both pleural effusion and ascites and diagnosis theiretiologyin comparison with cytology.

Method: This study is prospective study, 98 patients who admitted to Al-Hilla Surgical Teaching Hospital, 42 patients with pleural effusion and 56 patients with ascites. The investigations were done and include sugar and protein analysis, direct smears, tumor markers tests (CA125,CA15-3, CA19-9, CEA, NSE, and α-FP), and cytology are done for diagnosis of metastatic cancer in both effusions, or by histopathology if negative cytology are result.

Results: Pleural effusion (42 patients) are divided into 16 (38.1%) and 26 (61.9%) for benign and malignant effusion respectively, ascites (56 patients) are 33(58.9) and 23(41.1%) for benign and malignant ascites. The age group 71-80 and male gender group is the higher percentage in both effusions. Sensitivity and accuracy in pleural fluid CEA (30.8% and 57.1%), CA15-3 (26.9%,54.8%)respectively, and in ascitic fluid CA125 and CA19-9 (26.1%, 69.6%).Tumor markers have significant association inpleural effusion (CEA and CA15-3) and ascitic fluid (CEA, CA125, and CA19-9). Sensitivity and specificity of cytology in ascitic fluid (65.2%, 96.9%) and in pleural effusion (57.7%,93.8%)respectively with significant association in both effusion . In pleural effusions, CEA+ cytology result 44.2%, 64.3%, and In ascitic effusion, CA125 + cytology show 45.7%+77.7%, for sensitivity and accuracy respectively.

Conclusion: Tumor marker of both effusions have low sensitivity and high specificity. The combination tumor markers with each other and with cytology resulting in considerable increase in their diagnostic efficacy and they can use as director for invasive procedure cytology remain the highest sensitivity (in compare to tumor markers) and would bed one before other invasive tools.