The Value Of Cytokeratin 19 Fragment And Tissue Polypeptide Antigen Levels In Bronchoalveolar Lavage Fluid In Diagnosis Of Lung Cancer

Lung cancer is a maglinant tumor originated in lung. It is one of the most common carcinomas in the entire world.Most patients with lung cancer can be diagnosed by bronchofiberscope biopsy brush slide pathology, but the others (about 30%) can't be determined. With the aim of obtaining determination of lung cancer, some authors have proposed the detection of tumor markers. Now cytokeratin 19 fragment (CYFRA21-1) and tissue polypeptide antigen (TPA) are sufficiently sensitive and specific to have actual diagnostic usefulness .No report has shown TPA detection in bronchoalveolar lavage fluid (BALF) and combined detection in BALF in internal literature. The purpose of this study is to evaluate the diagnostic value of the assay CYFRA21-1 and TPA in BALF and to compare with serum assay in patients with lung cancer and benign pulmonary disease.Subjects and methods All specimens (BALF and serum)were obtained from the first and second Affiliated Hospital, Zhengzhou university. BALF was collected according to the method introduced by Zhao Mingwu. 60 histologicaly proven and previously untreated lung cancer patients have been prospectively studied. Lung cancer group consisted of 60 cases,41 males and 19 females, age 32-75y, mean age(57.43 +8.72)y, was divided into two groups, nonsmall cell lung cancer (NSCLC) and small cell lung cancer(SCLC), based on histology. NSCLC consisted of 49 cases, including 29 cases of squamous cell carcinoma, 15 of adenocarcinoma, 5 of large cell carcinoma? SCLC consisted of 11 cases. Clinical staging: In accordance with UICC'S TNM system(1997), NSCLC stage I-I1 29 cases, stage III-IV 20 cases; In accordance with lASLC'S clinical staiidard(1989), SCLE limited 5 cases, extensive 6 cases. Control group (benign pulmonary disease) consisted of 30 cases, 20 males and 10 females; age 30-76y, mean age (55.87+10.50)y; including 9 cases of pulmonary tuberchlosis, 8 of pneumonia, 10 of chronic bronchitis, 3 of bronchiectasis. CYFRA21-1 was detected with immunoradiometric assay (IRMA), TPA was dedected with enzyme linked immunosorbent assay (ELISA). The positive value for CYFRA21-1 is more than 3.3 u g/L in serum, 63.64 u g/L in BALF; The positive value for TPA is more than 1 u g/L in seram, 11.76 u g/L in BALF. With SPSS 10.0 soft wrap, x2 test and t test were used to analyze the data. There is a statistic significance whenp<0.05.CYFRA21-1 levels in BALF were 81.88 + 38.80 u g/L and 36.71 + 16.37ii g/L respectively. The CYFRA21-1 level was significantly higher in lung cancer group than in control group (p<0.01). In accordance with histological classification of lung cancer, the CYFRA21-1 levels in BALF were 88.40 + 38.21 P g/L for NSCLC and 52.84 + 27.19 P g/L for SCLC respectively, the CYFRA21-1 levels in patients with NSCLC were significantly higher than those in patienes with SCLC (pO.05). In NSCLC, the CYFRA21-1 levels in BALF were 100.17 + 42.25 u g/L for squamous cell carcinoma (Sq)and 69.91 +22.49 u. g/L for adenocarcirioma(AC) respectively, the CYFAR21-1 level was significantly higher in Sq than in AC,( PO.01 ).The levels of BALF CYFRA21-1 detected in I-II stage and III-IV stage patients with NSCLC were 71.55+28.87 u g/L and 112.83 + 37.40 g/L respectively. It is showed that the more advanced the clinical stages were, the higher the levels of CYFRA21-1 were (pxO.Ol) (2) The positive rate and specificity of CYFRA21-1 in BALF for lung cancer were 68.3% and 93.3% respectivdy. The positive rate and specificity of CYFRA21-1 for lung cancer in serum were 48.3% and 96.7% respectively. The positive rate of CYFRA21-1 for lung cancer was significantly higher in BALF than that in serum (p<0.05 ). While the specificity decreased from 96.7% of serum to 93.3% of BALF. The positive rate of CYFRA21-1 in BALF was 75.5% for NSCLC, 36.4% for SCLC. There was significant difference between NSCLC andSCLC (p<0.05). In stage MI of NSCLC, the positive rate of CYFRA21-1 in BALF and serum were 65.5% and 37.9% respectively. The positive rate of CYFAA21-1 was higher in BALF than that in serum (p<0.05) (3)...