The Role of Carcinoembryonic Antigen (CEA) and Neuron-Specific Enolase (NSE) Evaluation in Pericardial Fluid for the Recognition of Malignant Pericarditis

Abstract

This study was designed to assess the value of tumor marker evaluation in pericardial fluid for the recognition of malignant pericarditis. Thirty-six patients with signs and symptoms of large pericardial effusion entered the study. Pericardiocentesis with pericardial fluid drainage was performed in all of them. CEA and NSE levels were evaluated in the pericardial fluid and compared to pericardial fluid cytology. The median CEA value in malignant effusions was 80 ng/ml (range 0-305 ng/ml) and in non-malignant ones 1.26 ng/ml (range 0.2-18.4 ng/ml), p < 0.01. The sensitivity of CEA elevation above 5 ng/ml for the recognition of malignant pericarditis was 73% and the specificity was 90%. Pericardial fluid cytology was positive in 22 of 26 patients with malignant pericarditis (85%). CEA exceeding 5 ng/ml or positive cytology were seen in 96% of the patients with malignant pericarditis. The median NSE value in malignant pericardial effusions was 41.8 micrograms/l (range 2-172 micrograms/l) and in non-malignant ones 5.85 micrograms/l (range 1-83.9 micrograms/l), p < 0.3. For the differential diagnosis of large pericardial effusions we would recommend simultaneous cytologic examination of pericardial fluid and CEA assessment. NSE measurement in hemorrhagic pericardial fluid is of limited value.

Hyperosmolarity causes inflammation through the methylation of protein phosphatase 2A

“…The same is true for pericarditis [54], atherosclerosis [55], arthritis [56,57] or asthma and pneumonia [58]. Each time there is inflammation, there appears to be an increase in the amount of protein in the extracellular space.…”

Heart and tumors: location, metastasis, clinical manifestations, diagnostic approaches and therapeutic considerations

“…Fluid obtained by needle or surgical drainage should be studied for cells, including histochemical staining. Carcinoembryonic antigen and neuron-specific enolase should be sought [58].…”

Tumormarker im Perikarderguss bei malignen und nichtmalignen Perikardergüssen

“…In diesem Kontext wird neben der Periund Epikardbiopsie [1,4,5,8,9,11,12,14] die Bestimmung von Biomarkern im Erguss, insbesondere von Tumormarkern, in die ätiologische Diagnostik des Perikardergusses einbezogen. Die diagnostische Wertigkeit der Bestimmung von Tumormarkern in der durch Perikardpunktion gewonnenen Perikardflüssig-keit wurde allerdings bisher nur in wenigen Arbeiten untersucht [2,15,16] …”

“…Perikardiale CA-72-4-Konzentrationen über 1 kU/l erzielten eine Sensitivität von 72% bei einer Spezifität von 96% und CA-72-4-Konzentrationen über 2,5 kU/l eine Sensitivität von 69% bei einer Spezifität von 96% in der Differenzierung zwischen malignen und nichtmalignen Perikardergüssen. Im Vergleich zu den Arbeiten von Koh et al [2] und Szturmowicz et al [15,16] …”