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Catalog ID CEA FL Carcinoembryonic Antigen, Fluid

Additional Codes

CPOE: Ref Carcinoembryonic Antigen, Fluid

DOE: Ref CEA FL

Specimen

CSF, Pancreatic, Pericardial, Peritoneal/Ascites, or Pleural Fluid [Specimen source MUST be provided]

1.0 mL fluid (0.5 mL minimum), centrifuged with supernatant transfered to transport tube, refrigerated

Rejection Criteria

Specimens other than those listed, specimens too viscous to be aspirated by instrument, specimens at room temperature >8 hours, insufficient quantity, unlabelled specimen

Interpretative Information

CSF

Clinical Indications

  • Supportive evidence in the evaluation of suspected leptomeningeal carcinomatosis
  • Body fluid tumor markers should NOT be used as sole evidence of malignancy for diagnostic purposes and should be reviewed in correlation with cytology, serum results, and other clinical evidence. Results should be interpreted with caution when considering literature-based sources of interpretive guidance, as alternative assays and/or instruments are frequently used between studies.

Reference Interval and/or Interpretive Information

  • Elevations in cerebrospinal fluid (CSF) carcinoembryonic antigen (CEA) have been shown in certain cases of leptomeningeal carcinomatosis. [1,2,3,4]
  • Results should be reviewed in correlation with cytology, serum results, and other clinical evidence.

References

  • [1] Corsini E, Bernardi G, Gaviani P, Silvani A, de Grazia U, Ciusani E, Croci D, Salmaggi A. 2009. Intrathecal synthesis of tumor markers is a highly sensitive test in the diagnosis of leptomeningeal metastasis from solid cancers. Clin Chem Lab Med. 47(7):874-879. PMID: 19453289.
  • [2] Klee GG, Tallman RD, Goellner JR, Yanagihara T. 1986. Elevation of carcinoembryonic antigen in cerebrospinal fluid among patients with meningeal carcinomatosis. Mayo Clin Proc. 61(1):9-13. PMID: 3510343.
  • [3] Nakagawa H, Kubo S, Murasawa A, Nakajima S, Nakajima Y, Izumoto S, Hayakawa T. 1992. Measurements of CSF biochemical tumor markers in patients with meningeal carcinomatosis and brain tumors. J Neurooncol. 12(2):111-20. PMID: 1560255.
  • [4] Yap BS, Yap HY, Fritsche HA, Blumenschein G, Bodey GP. 1980. CSF Carcinoembryonic antigen in meningeal carcinomatosis from breast cancer.  JAMA. 244(14):1601-1603. PMID: 7420663.

PANCREATIC

Clinical Indications

  • Supportive evidence in evaluation of pancreatic cystic lesions
  • Body fluid tumor markers should NOT be used as sole evidence of malignancy for diagnostic purposes and should be reviewed in correlation with cytology, serum results, and other clinical evidence. Results should be interpreted with caution when considering literature-based sources of interpretive guidance, as alternative assays and/or instruments are frequently used between studies.

Reference Interval and/or Interpretive Information

  • A pooled analysis of 12 studies investigating pancreatic cyst fluid found that a CEA of >800 ng/mL had a sensitivity of 48% and a specificity of 98% in distinguishing mucinous cystadenoma and mucinous cystadenocarcinoma from serous cystadenoma and pseudocyst. [1]
  • A CEA <5 ng/mL was 54% sensitive and 94% specific for identifying serous cystadenoma and/or pseudocyst. [1]
  • In a review of 124 pancreatic cyst fluids (with histologic confirmation), a CEA level ≥ 200 ng/mL had a sensitivity of 60% and a specificity of 93% for identifying mucinous pancreatic lesions. [2]
  • CEA levels did not differentiate benign from malignant mucinous cysts. [2]
  • A separate 2004 multicenter study found that CEA (at a 192 ng/mL cutoff) had a 73% sensitivity and 84% specificity in differentiating between mucinous and non-mucinous lesions. [3]
  • A 2009 study used a CEA cutoff of >30 ng/mL (as one component of a testing and interpretation algorithm) to help differentiate mucinous from non-mucinous cysts. [4]
  • A wide range of within-group CEA concentrations was noted.
  • Results should be reviewed in correlation with cytology, serum results, and other clinical evidence.

References

  • [1] Van der Waaij LA, van Dullemen HM, Porte RJ. 2005. Cyst fluid analysis in the differential diagnosis of pancreatic cystic lesions: a pooled analysis. Gastrointestinal Endoscopy. 62(3):383-389. PMID: 16111956.
  • [2] Park WG, Mascarenhas R, Palaez-Luna M, Smyrk TC, O’Kane D, Clain JE, Levy MJ, Pearson RK, Petersen BT, Topazian MD, Vege SS, Chari ST. 2011. Diagnostic performance of cyst fluid carcinoembryonic antigen and amylase in histologically confirmed pancreatic cysts. Pancreas. 40(1):42-45. PMID: 20966811.
  • [3] Brugge WR, Lewandrowski K, Lee-Lewandrowski E, Centeno BA, Szydlo T, Regan S, del Castillo CF, Warshaw AL, and the Investigators of the CPC Study. 2004. Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology. 126:1330-1336. PMID: 15131794.
  • [4] Snozek CLH, Mascarenhas RC, O’Kane DJ. 2009. Use of cyst fluid CEA, CA19-9, and amylase for evaluation of pancreatic lesions. Clinical Biochemistry. 24:1585-1588. PMID: 19576876.

PERICARDIAL

Clinical Indications

  • Supportive evidence in the evaluation of suspected malignant pericarditis
  • Body fluid tumor markers should NOT be used as sole evidence of malignancy for diagnostic purposes and should be reviewed in correlation with cytology, serum results, and other clinical evidence. Results should be interpreted with caution when considering literature-based sources of interpretive guidance, as alternative assays and/or instruments are frequently used between studies.

Reference Interval and/or Interpretive Information

  • Elevations in CEA have been observed in certain cases of malignant pericarditis. [1,2,3]
  • While limited data is available, one study of 36 patients reported that a pericardial fluid CEA cutoff >5 ng/mL had a sensitivity of 73% and a specificity of 90% for the recognition of malignant pericarditis. [1]
  • Results should be reviewed in correlation with cytology, serum results, and other clinical evidence.

References

  • [1] Szturmowicz M, Tomkowski W, Fijalkowska A, Burakowski J, Sakowicz A, Filipecki S. 1997. The role of carcinoembryonic antigen (CEA) and neuron-specific enolase (NSE) evaluation in pericardial fluid for the recognition of malignant pericarditis. Int J Biol Markers. 12(3):96-101. PMID: 9479590.
  • [2] Szturmowicz M, Tomkowski W, Fijalkowska A, Kupis W, Cieslik A, Demkow U, Langfort R, Wiechecka A, Orlowshi T, Torbicki A. 2005. Diagnostic utility of CYFRA 21-1 and CEA assays in pericardial fluid for the recognition of neoplastic pericarditis. Int J Biol Markers. 20(1):43-9. PMID: 15832772.
  • [3] Tatsuta M, Yamamura H, Yamamoto R, Ichii M, Iishi H, Noguchi S. 1984. Carcinoembryonic antigens in the pericardial fluid of patients with malignant pericarditis. Oncology. 41(5):328-30. PMID: 6472769.

PERITONEAL/ASCITES

Clinical Indications

  • Supportive evidence in evaluation of suspected malignant ascites
  • Body fluid tumor markers should NOT be used as sole evidence of malignancy for diagnostic purposes and should be reviewed in correlation with cytology, serum results, and other clinical evidence. Results should be interpreted with caution when considering literature-based sources of interpretive guidance, as alternative assays and/or instruments are frequently used between studies.

Reference Interval and/or Interpretive Information

  • An ascites fluid CEA (at a cutoff of 3.5 ng/mL) showed a 31% sensitivity and 95% specificity for the differentiation of malignant from non-malignant ascites in one report. [1]
  • Higher concentrations of ascites fluid CEA were observed in malignancies which are known to elevate CEA in the serum. [1]
  • Results should be reviewed in correlation with cytology, serum results, and other clinical evidence.

References

  • [1] Kaleta EJ, Tolan NV, Ness KA, O’Kane DO, Algeciras-Schimnich A. 2013. CEA, AFP, and CA 19-9 analysis in peritoneal fluid to differentiate causes of ascites formation. Clinical Biochemistry. 46:814-818. PMID: 23454391.

PLEURAL

Clinical Indications

  • Supportive evidence in evaluation of suspected malignant pleural effusion
  • Meta-analyses do not support the routine use of single tumor markers for the diagnosis of malignant pleural effusions [1,2]
  • British Thoracic Society 2010 pleural disease guideline states that pleural fluid tumor markers do not have a role in the routine analysis of pleural effusions [3]
  • Body fluid tumor markers should NOT be used as sole evidence of malignancy for diagnostic purposes and should be reviewed in correlation with cytology, serum results, and other clinical evidence. Results should be interpreted with caution when considering literature-based sources of interpretive guidance, as alternative assays and/or instruments are frequently used between studies.

Reference Interval and/or Interpretive Information

  • A CEA cutoff of ≥3.5 ng/mL demonstrated a 52% sensitivity and 96% specificity for detection of malignant pleural effusions in one report. [4]
  • In that report CEA concentrations were typically not elevated when the effusion was due to malignancies that are not associated with serum elevations of CEA. [4]
  • Results should be reviewed in correlation with cytology, serum results, and other clinical evidence.

References

  • [1] Liang QL, Shi HZ, Qin XJ, Liang XD, Yang HB. 2008. Diagnostic accuracy of tumour markers for malignant pleural effusion: a meta analysis. Thorax. 63:35-41. PMID: 17573438.
  • [2] Nguyen AH, Miller EJ, Wichman CS, Berim IG, Agrawal DK. 2015. Diagnostic value of tumor antigens in malignant pleural effusion: a meta-analysis. Translational Research. Epub ahead of print. PMID: 25953662.
  • [3] Hooper C, Lee YCG, Maskell N, on behalf of the BTS Pleural Guideline Group. 2010. Investigation of a unilateral pleural effusion in adults: British Thoracic Society pleural disease guideline 2010. Thorax. 65(Suppl 2):ii4-ii17. PMID: 20696692.
  • [4] Hackbarth JS, Murata K, Reilly WM, Algeciras-Schimnich A. 2010. Performance of CEA and CA19-9 in identifying pleural effusions caused by specific malignancies. Clinical Biochemistry. 43:1051-1055. PMID: 20529669.

Performing Lab

ARUP Laboratories

Turn-Around-Time

<24 hours from specimen receipt by ARUP Laboratories

Reference Values

See report