NIH, National Cancer Institute, Division of Cancer Treatment and Diagnosis (DCTD) NIH - National Institutes of Health National Cancer Institute DCTD - Division of Cancer Treatment and Diagnosis

Long-term stability of pleural fluid carcinoembryonic antigen and its effect on the diagnostic accuracy for malignant pleural effusion.

Author(s): Yang DN, Niu Y, Wen JX, Wen XH, Wang YF, Yan L, Jiang TW, Huang JH, Chen H, Lippi G, Zheng WQ, Hu ZD

Publication: Thorac Cancer, 2023, Vol. 14, Page 2077-2084

PubMed ID: 37314828 PubMed Review Paper? No

Purpose of Paper

This paper compared levels of carcinoembryonic antigen (CEA) in pleural fluid from two cohorts prior to (fresh) and following storage at -70°C to -80°C for 1-3 years.

Conclusion of Paper

While small but significant differences in CEA levels were found between fresh and frozen pleural fluid, statistical significance and the direction of the change were dependent on the cohort and the malignancy of the specimen (malignant versus benign). Further, storage duration and CEA levels were not correlated, and the sensitivity of CEA levels for malignancy was comparable for fresh and frozen specimens. Although overall there was good agreement between CEA levels in fresh and frozen specimens, the 95% confidence interval for the intercept of the Deming regression in the Hohhot cohort specimens did not cover 1.

Studies

  1. Study Purpose

    This study compared levels of CEA in pleural fluid collected from two cohorts prior to (fresh) and after storage at -70°C to -80°C for 1-3 years. Pleural fluid was collected into anticoagulant-free tubes at two sites from patients with undiagnosed pleural effusion who underwent a diagnostic thoracentesis. The Affiliated Hospital of Inner Mongolia Medical University from Hohhot collected pleural fluid from 152 patients (65 malignant pathologies and 87 benign) in its respiratory and intensive care department between September 2018 and July 2021. Pleural fluid was also collected from 58 patients (26 malignant pathologies and 32 benign) who visited the Changshu No. 2 People’s Hospital between June 2020 and July 2021. Pleural fluid was centrifuged (details not provided) and the supernatant was stored at -70°C to -80°C from collection until analysis in January-April 2022. CEA levels were measured in fresh and frozen CEA using an Abbott I2000SR immunoassay.

    Summary of Findings:

    When all specimens were considered (both cohorts) CEA levels were slightly higher in frozen than fresh pleural fluid (P<0.01). Interestingly, while CEA levels were slightly higher in frozen than fresh benign pleural fluid (1.35 versus 1.29, P<0.01), they were non-significantly lower in frozen than fresh malignant pleural fluid (41.23 versus 47.46, P=0.07).  In specimens from the Hohhot cohort, CEA levels were higher in frozen pleural fluid than fresh (2.61 versus 2.23, P<0.01) when all specimens were considered (malignant and benign), higher in benign frozen specimens than fresh (1.41 versus 1.18, P<0.01), but lower in frozen than fresh malignant specimens (36.86 versus 40.77, P<0.01). In specimens from the Changshu cohort, CEA levels were lower in frozen pleural fluid than fresh when all specimens were considered (2.44 versus 2.78, P<0.01) and in benign (1.19 versus 1.36, P=0.02) and malignant specimens (46.55 versus 51.98, P=0.03).  Storage duration and CEA levels were not correlated, and overall there was good agreement between CEA levels in fresh and frozen specimens; for the Hohhot cohort, the 95% confidence interval for the intercept of the Deming regression did not cover 1. The receiver operating characteristic curves were similar for fresh and frozen pleural specimens, with an overall sensitivity of 89% and 88%, respectively, and comparable sensitivities in fresh and frozen specimens from the Hohhot (87% and 86%, respectively) and Changshu cohorts (93% and 91%, respectively).

    Biospecimens
    Preservative Types
    • None (Fresh)
    • Frozen
    Diagnoses:
    • Neoplastic - Not specified
    • Other diagnoses
    • Neoplastic - Carcinoma
    • Neoplastic - Benign
    Platform:
    AnalyteTechnology Platform
    Protein Clinical chemistry/auto analyzer
    Pre-analytical Factors:
    ClassificationPre-analytical FactorValue(s)
    Biospecimen Preservation Type of fixation/preservation Frozen
    None (fresh)
    Storage Storage duration 0 years
    1-3 years
    Biospecimen Acquisition Locale of biospecimen collection Affiliated Hospital of Inner Mongolia Medical University from Hohhot
    Changshu No. 2 People’s Hospital

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