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The usefulness of the determination of carcinoembryonic antigen (CEA) in pleural effusion was assessed as an aid to the diagnosis of malignant mesothelioma. The concentration of CEA was determined by radioimmunoassay (RIA) in pleural fluid of 213 adult patients, of which 140 had malignant pleural disease and 73 had nonmalignant pleural disease. Pleural fluid CEA (PF CEA) was lower than 12 ng/ml in all 15 mesotheliomas. The statistical probability of a mesothelioma associated with PF CEA greater than 15 ng/ml was found to be zero. The CEA assay in pleural effusion proved to be a valuable adjunct to other diagnostic procedures in differentiating the malignant mesothelioma from metastatic serosal spread. Cancer 53:1194‐1197, 1984.

The usefulness of tumor marker assay in pleural effusions for differential diagnosis is still debated. From the observation of common antigens on tissue polypeptide antigen (TPA) and keratins 8, 18 and 19 and vimentin, all substances contained in normal and neoplastic mesothelium, we felt it opportune to evaluate the use of TPA assay in 105 pleural effusions (46 benign and 59 malignant). The values were much higher than those found in blood. In hydrothorax the median value was 454 U/l (range, 59-1923), in exudative effusions 846 U/l (range, 258-4485), in metastatic pleural effusions 1277 U/l (range, 58-32352) and in mesotheliomas 7705 (range, 759-16000). The maximum value found in nonmalignant effusions was 4485 U/l; this value was taken as a cutoff level, so only 29.9% of the tumors were positive to the test. Our results showed this assay to be not very important for a differential diagnosis of malignant and nonmalignant pleural effusions. Nevertheless, the different TPA patterns in mesotheliomas (66.6% positive) and metastatic pleural effusions (15.9%) suggest that further studies are warranted.

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Background:The lung is the most common distant metastasis site from oral tongue cancer (OTC). However, there have been no reports on surgical resection results for pulmonary OTC metastases. The aim of this study was to evaluate surgical resection for OTC pulmonary metastases efficacy. Methods: Between 1977 and 2003, 23 OTC patients who developed 1 to 3 pulmonary metastases underwent metastasectomy. The clinicopathologic features and long-term outcomes were examined. Results: The 14 men and 9 women had a median age at the time of pulmonary metastasectomy of 56 (range; 28-72 years). All 23 patients had advanced squamous cell OTC with regional lymph node involvement or subsequent regional lymph node metastasis. The median tumor-free interval after the initial OTC treatment was 17 months (range: 1-165 months). Five patients had pneumonectomy, three bilobectomy, 13 lobectomy, and two wedge resection. Two patients underwent a second pulmonary metastasectomy. One patient continues to survive, without recurrence at 229 months right now. Twenty-two patients developed systemic metastases. The interval to systemic metastasis recurrence after pulmonary resection ranged from 1 to 17 months (median, 3.5 months) and 21 died of OTC at 9.5 months median (range: 1-26 months) after metastasectomy. One patient was alive with disease at 24 months after metastasectomy but was lost to follow-up. Conclusions: Most patients who had OTC pulmonary metastasectomy died of the disease within two years. Even for patients with a solitary metastasis, surgical resection for OTC pulmonary metastases is not a recommended treatment option.