• Ying Zhang, Xiaoou Li, Junhui Liu, Xueru Hu, Chun Wan, Rui Zhang, and Yongchun Shen.
• Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.
• Ann. Med. 2021 Dec 1; 53 (1): 558566558-566.

ObjectiveThis study aimed to assess the diagnostic accuracy of serum LDH to pleural ADA ratio (cancer ratio, CR)for malignant pleural effusion (MPE) through an original study and meta-analysis.MethodsWe retrospectively collected data from 145 patients with MPE and 117 cases of benign pleural effusions (BPE). The diagnostic performance of CR and a typical biomarker of MPE, carcinoembryonic antigen (CEA), were analysed using the receiver operating characteristic (ROC) curves and the area under the curve (AUC) as a measure of accuracy. The overall diagnostic accuracy of CR was summarised by a standard diagnostic meta-analysis.ResultsSignificantly higher CR and pleural CEA values were observed in the MPE patients than in the BPE patients. At a cut-off value of 14.97, CR showed high sensitivity (0.91), low specificity (0.67), and high AUC (0.85). The combination of CEA and CR increased the AUC to 0.98. The meta-analysis included seven studies involving 2,078 patients. The pooled values for sensitivity, specificity, positive/negative likelihood ratio, and diagnostic odds ratio of CR were 0.96, 0.88, 7.70, 0.05, and 169, respectively. The AUC of the summary ROC of CR was 0.98.ConclusionCR has a high diagnostic accuracy for predicting MPE, especially when used in combination with pleural CEA.

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