Diagnostic utility of pleural fluid carcinoembryonic antigen and CYFRA 21-1 in patients with pleural effusion: A systematic review and meta-analysis

Full text: Objective: To assess and compare the overall value of pleural fluid CEA and CYFRA 21-1 in differential diagnosis of pleural effusions with a meta-analysis. Methods: All the English and Chinese published studies for differential diagnosis of pleural effusions by pleural fluid CEA and CYFRA 21-1 were collected. Methodological quality of the included studies was then evaluated. Pooled sensitivity and specificity were calculated, the threshold effect and the possible sources of heterogeneity were also analyzed. SROC (summary receiver operating characteristic) was used to compare the differential diagnostic ability of pleural fluid CEA and CYFRA 21-1. Results: 19 studies were included in the meta-analysis, with a total of 3228 subjects. Pooled sensitivity and specificity of CEA and CYFRA 21-1 were 45.9%(43.2%- 48.5%),97.0%(96.0%-97.8%) and 47.3%(44.0%- 50.6%),91.8%(89.5%-93.7), respectively. Both CEA and CYFRA 21-1 have a threshold effect, the main source of heterogeneity was from variable assay methods. AUC (area under the curve) of CEA and CYFRA 21-1 were 0.7691 and 0.8213, respectively. There was no statistical significance between the AUC of CEA and CYFRA 21-1 (p>0.05). Conclusion: Both CEA and CYFRA 21-1 have good performance at differential diagnosis of pleural effusion, while compared with CEA, CYFRA 21-1 has no advantage. (author)