Detection Of HTERT MRNA, CEA And CA19-9 In Pleural Effusion And Its Clinical Values

Objectives To detect the expression of human telomerase reverse transcriptase mRNA (hTERT mRNA) of exfoliated cells and to assay the concentrations of carcino- embryonic antigen (CEA) and carbohydrate antigen19-9(CA19-9) in Pleural fluids, and investigate their diagnostic values on differentiation between malignant and benign effusions.Methods Eighty-six specimens of fresh pleural fluids were collected from 86 patients and were divided into malignant group and benign group according to the clinical data. Malignant group has 44 specimens and the benig one has 42. The concentrations of CEA, CA19-9 in pleural fluids of these specimens were assayed by immunoradioassay and automated chemiluminescence, respectively. hTERT mRNA in the exfoliative cells of effusions were detected by RT-PCR. The expression level of hTERT mRNA, CEA and CA19-9 in the two groups were calculated, and their diagnostic positive rates and their sensitivities, specificities as well as diagnosis accordance rates were evaluated.Results Of the 86 specimens, the expression of hTERT mRNA was detected in 36(81.8%) of 44 samples from cancer cases and only 4(9.5%)of all specimens from benign cases. The difference of hTERT mRNA expression among two groups of specimens were statistically significant (P﹤0.05). The differences of CEA, CA19-9 contents between there two groups were statistically significant (P﹤0.05). Using the cut-off values 20ng/ml, 37U/ml for pleural fluid CEA, CA19-9, the difference positive rates of them between two groups were significant (P﹤0.05). The differences positive rates of combined detection for the three markers between these two groups were statistically significant (P﹤0.05). The combined assay of three tumor markers in pleural effusions were helpful and can increase the sensitivity and diagnositic accordance rates in diagnosing malignant pleural effusions, the diagnostic efficiency of hTERT mRNA and CA19-9 combined is best. Therefore, sensitivity (%), specificity (%) and diagnositic accordance rates (%)of these tumor markers were as follows: hTERT mRNA: 81.8/90.5/86.1, CEA: 52.3/92.9/72.1, CA19-9: 34.1/90.5/ 61.6, hTERT mRNA+CEA: 97.7/83.3/90.7. Conclusions1. hTERT mRNA is highly expressed in the exfoliative cells of malignant pleural effusions, and rarely in benign effusions.2. The contents of CEA, CA19-9 in malignant pleural effusions is obviously increased, while comparatively lower in benign one.3. The detection of hTERT mRNA has rather high sensitivity and specificity for diagnosis of malignant pleural effusions. The detection of CEA has rather high specificity. hTERT mRNA and CEA are very useful for the differential diagnosis between malignant and benign effusions,but hTERT mRNA is better. The maker of CA19-9 is not fit to be the first index to be choosen among the three markers because of its low sensitivity.4. The combined assay of three tumor markers in pleural effusions were helpful and can increase the sensitivity and diagnostic accordance rate in diagnosing malignant pleural effusions. Thecombination of hTERT mRNA and CEA is best.