Diagnostic value of interleukin 22 and carcinoembryonic antigen in tuberculous and malignant pleural effusions

Abstract

Abstract. The aim of this study was to investigate the diagnostic value of interleukin 22 (IL-22) and carcinoembryonic antigen (CEA) in tuberculous pleural effusions (TPEs) and malignant pleural effusions (MPEs). Pleural effusion samples from 56 patients were classified on the basis of diagnosis as TPE (n=28) and MPE (n=28). The concentration of IL-22 was determined by ELISA. Lactate dehydrogenase (LDH), adenosine dehydrogenase (ADA) and CEA levels were also determined in all patients. A significant difference was observed in the levels of ADA and CEA (P<0.01), but not in the levels of LDH (P>0.05) between TPE and MPE. The concentration of IL-22 in TPE was significantly higher compared to MPE (P<0.01). With a threshold value of 49 pg/ml, IL-22 had a sensitivity of 82.14% (23/28) and a specificity of 96.43% (27/28) for differential diagnosis. The combined detection of IL-22 and CEA had a sensitivity of 100% (28/28) and a specificity of 96.43% (27/28) to distinguish TPE from MPE. TPEs showed significantly higher levels of IL-22 compared to MPEs. The combined detection of IL-22 and CEA may be more valuable in the differential diagnosis between TPE and MPE. IntroductionPleural effusion is one of the most common clinical manifestations of pleural diseases (1-3). According to clinical risk factors and prognosis, pleural effusion can be divided into two categories, benign and malignant (4). The most common cause of benign pleural effusion is tuberculosis (TB), and that of malignant pleural effusion (MPE) is lung and breast cancer (5). Due to different risk factors and prognosis, it is necessary to differentiate between them. However, this remains a major clinical problem. Although the presence of tumor cells in pleural effusion is a diagnostic marker of MPE, the probability of finding them is low. For cytology-negative pleural effusion, some of the currently used indices, such as lactate dehydrogenase (LDH), adenosine dehydrogenase (ADA) and carcinoembryonic antigen (CEA), have a certain extent of differential value, however, their specificity and sensitivity are limited. Due to the fear of possible trauma caused by thoracoscopy, some patients are not keen to agree on such a procedure. Therefore, searching for new indices is very important.The improved understanding of pleural effusion immunopathogenesis could lead to the development of new immunodiagnostic tools to facilitate its differential diagnosis. The main cellular components in both tuberculous pleural effusions (TPEs) and MPEs are lymphocytes. Previous research data have reported that lymphocytes play an important regulatory role in the pathogenesis of pleural effusion (1,2). Inflammation leads to the accumulation of lymphocytes in the pleural cavity, which release a variety of mediators and cytokines influencing pleural capillary permeability, resulting in pleural effusion (6,7). Large scale studies have reported that CD4 + T lymphocytes play an important role in the pathogenesis of pleural effusion (7). CD4 + T cells can be differentiated into Th1, Th2, Th17...

Age and sex distribution in malignant and tuberculous serous effusions: A study of 127 patients and review of the literature

“…Jin et al . observed a difference in age (mean ± SD) between TPE and MPE ( P < 0.01); a significant difference was also observed by them between MPE and TPE in respect of levels of ADA and CEA ( P < 0.01); the concentration of interleukin‐22 in TPE was significantly higher compared with MPE ( P < 0.01) . These authors concluded that the combined detection of interleukin‐22 and CEA might be more valuable in the differential diagnosis between TPE and MPE .…”

“…observed a difference in age (mean ± SD) between TPE and MPE ( P < 0.01); a significant difference was also observed by them between MPE and TPE in respect of levels of ADA and CEA ( P < 0.01); the concentration of interleukin‐22 in TPE was significantly higher compared with MPE ( P < 0.01) . These authors concluded that the combined detection of interleukin‐22 and CEA might be more valuable in the differential diagnosis between TPE and MPE . Liu et al ., in a study population comprising patients with lymphocytic exudative pleural effusions (24 tuberculous and 42 malignant), observed a significant difference between TPE and MPE in age distribution ( P < 0.05); mean levels of ADA and interferon‐γ in pleural fluid were significantly higher for tuberculous than malignant pleurisy ( P < 0.001) …”

“…According to Antony et al ., nearly all neoplasms have been reported to involve the pleura; however, lung carcinoma has been the most common neoplasm, followed by breast carcinoma and lymphomas; tumors less commonly associated with MPE include ovarian and gastrointestinal carcinomas . A review of the literature showed that clinical features, such as age, body temperature, weight loss and so on, act as supplementary features to the laboratory diagnostic parameters in differentiating malignant from tuberculous serous effusions involving pleural and peritoneal cavities . According to Villegas et al ., fever and younger age were associated with tuberculous pleural effusion (TPE; P < 0.0001), whereas blood in sputum and older age were associated with malignant etiology ( P < 0.008); these clinical variables together with the use of ADA activity, polymerase chain reaction and measurement of interferon‐γ levels provided the basis for rapid and efficient diagnosis of pleural tuberculosis in different clinical settings.…”

“…In cancer patients with direct involvement of serous membranes, the pleural fluid cytology is frequently negative; this happens because in routine cytological examination of effusions, it is sometimes difficult to distinguish benign cells from malignant cells when neoplastic cells show only mild atypia or the reactive mesothelial cells show marked atypia, and there are only a few target cells . Other studies also suggest that the presence of tumor cells in pleural effusion, which is diagnostic of malignant pleural effusion (MPE), is associated with a low probability of their detection . Whereas pleural tuberculosis (PT) is a diagnostic challenge because of its non‐specific clinical presentation and paucibacillary nature, the rate of preoperative misdiagnosis between peritoneal tuberculosis and ovarian cancer is high because of overlapping non‐specific signs and symptoms .…”

Biological and pathological activities of interleukin-22

“…In recent studies, high levels of IL-22 and Th22 were found in the primary lung tumor as well as in the malignant pleural effusions [139, 154, 155]. IL-22 exhibited anti-apoptotic effects in lung cancer xenografts [156] and induced growth of chemoresistant cancer cells [138].…”