The Analysis Of Diagnostic Consistency Of Tumor Markers、ADA In Benign And Malignant Pleural Effusions Diagnosed By Medical Thoracoscopy

Objective Investigate the diagnostic consistency of the molecular makers,such as tumor markers and ADA,in the benign and malignant pleural effusions diagnosed by pleural biopsy through medical thoracoscopy,and discuss its diagnostic value of combination detection.Method37cases of tuberculous pleural effusions and80cases of cancerous pleural effusions,which had been diagnosed by pleural biopsy through medical thoracoscopy in Shandong Provincial Hospital in2012-2014,were selected retrospectively and divided into the benign and malignant group respectively.The levels of carcinoembryonic antigen(CEA),neuron specific enolase(NSE),cytokeratin19fragment(CYFRA21-1) and adenosine deaminase(ADA) in serum and pleural effusions of the two groups would be determined by chemical luminescent method and enzyme chemical method.The statistics would be analyzed by the SPSS21.0to evaluate the significance of these indexes in the diagnosing of pleural effusions.Results1.The concentrations of pleural CEA(150.21±292.06ng/ml),NSE(42.79±87.72ng/ml) and CYFRA21-1(157.06±173.30ng/ml) in malignant group are higher than those in TB group,which has the statistical significance(p<0.05).2.The concentration of pleural ADA(43.23±19.05U/L) in TB group is significantly higher than that in malignant group(10.49±5.65U/L).3.The concentrations of CEA,NSE,CYFRA21-1in serum in malignant group are higher than those in TB group,but which has no statistical significance(p>0.05).4.1n malignant group,the concentration of CEA in adenocarcinoma group is significantly higher than those in SCLS group,squamous cell carcinoma group and malignant mesothelioma group.The concentration of NSE in SCLC group is significantly higher than those in other subgroups.And the concentration of CYFRA21-1in squamous cell carcinoma group is significantly higher than those in other subgroups(p<0.05).5.In single measurement,CEA reached the specificity of100%and CYFRA21-1got a high sensitivity of96.25%.In combination measurements of CEA and NSE,CEA and CYFRA21-1,NSE and CYFRA21-l,the sensitivity and specificity would be higher than single measurement.The parallel test of CEA,NSE,CYFRA21-1combination measurement got the highest sensitivity of100%,and the sequence test reached the highest specificity of100%.Conclusion1.Pleural biopsy through medical thoracoscopy comes to the "gold standard" of differential diagnosis of benign and malignant pleural effusions.2.The concentrations of pleural CEA,NSE,CYFRA21-1in malignant pleural effusions diagnosed by pleural biopsy through medical thoracoscopy are significantly higher than those in tuberculous pleural effusions.And the ADA in tuberculous pleural effusions comes higher than that in malignant effusions.3.When in the primary hospital without thoracoscopy or confronting with the contraindications of thoracoscopy,the levels of CEA,NSE,CYFRA21-1,ADA in pleural effusions are significant in differential diagnosis of benign and malignant pleural effusions.4.CEA makes a specific role in diagnosing of adenocarcinoma than other kinds of cancers,which do same as NSE to SCLC and CYFRA21-1to the squamous cell carcinoma. 5.The combination detection of CEA,NSE,CYFRA21-1will improve the sensitivity and specificity,which can be applied in clinic to improve the diagnostic yield.