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Open Access Highly Accessed Research article

Additional diagnostic value of tumor markers in cytological fluid for diagnosis of non-small-cell lung cancer

Jin Hur1, Hye-Jeong Lee1, Ji Eun Nam1, Young Jin Kim1, Yoo Jin Hong1, Hee Yeong Kim1, Se Kyu Kim2, Joon Chang2, Joo-Hang Kim23, Kyung Young Chung4, Hye Sun Lee5 and Byoung Wook Choi16*

Author Affiliations

1 Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

2 Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

3 Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

4 Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

5 Department of Biostatistics, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

6 Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, 120-752, Republic of Korea

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BMC Cancer 2012, 12:392  doi:10.1186/1471-2407-12-392

Published: 7 September 2012

Abstract

Background

Cytological fluid from a needle aspiration biopsy (NAB) is obtained directly from tumor tissue, therefore many biomarker candidates will be present in high concentrations. The aim of this study was to prospectively assess and validate the tumor markers CYFRA 21–1, CEA, and SCC in cytological fluid obtained from NAB samples to determine if they improved the performance of NAB for diagnosing non-small cell lung cancer (NSCLC).

Methods

A total of 194 patients (M:F = 128:66, mean age 63.7 years) with suspected malignant pulmonary lesions were prospectively enrolled and underwent percutaneous NAB. Levels of CYFRA 21–1, CEA, and SCC were measured by immunoassay in serum and cytological fluid obtained during aspiration biopsy. Cut-off values to determined malignancy were 3.3 ng/mL in serum and 15.7 ng/mL in cytological fluid for CYFRA 21–1, 5 ng/mL and 0.6 ng/mL for CEA, and 2 ng/mL and 0.86 ng/mL for SCC.

Results

Of 194 patients, 139 patients (71.6%) had NSCLC and 55 (28.4%) had benign lesions. Sensitivity increased significantly for NAB combined with cytological tumor markers compared with NAB alone (CYFRA 21–1: 95% versus 83.5%, p < 0.001, CEA: 92.1% versus 83.5%, p = 0.002, SCC: 91.4% versus 83.5%, p = 0.003). Accuracy improved significantly for NAB combined with cytological CYFRA 21–1 compared with NAB alone (95.9% versus 88.1%, p < 0.001). The area under curve (AUC) of NAB with cytological CYFRA 21–1 was significantly larger than for NAB alone (0.966 versus 0.917, p = 0.009).

Conclusion

Of the tested tumor markers, cytological fluid measurements of CYFRA 21–1 improved the diagnostic performance of NAB for NSCLC.

Keywords:
Cytokeratin 19 fragments (CYFRA 21–1); Carcinoembryonic antigen (CEA); Squamous cell carcinoma antigen (SCC); Needle aspiration biopsy (NAB); Tumor marker; Cytological fluid; Non-small cell lung cancer (NSCLC)