Body fluid analysis: Clinical utility and applicability of published studies to guide interpretation of today’s laboratory testing in serous fluids

References

• Deeks JJ, Altman DG. Diagnostic tests 4: likelihood ratios. BMJ 2004;329:168–9
   PubMed Web of Science ®Google Scholar
• Jenkinson F, Murphy MJ. Biochemical analysis of pleural and ascitic fluid: effect of sample timing on interpretation of results. Ann Clin Biochem 2007;44:471–3
   Google Scholar
• Schoenicke G, Grabensee B, Plum J. Dialysis with icodextrin interferes with measurement of serum alpha-amylase activity. Nephrol Dial Transplant 2002;17:1988–92
   PubMed Web of Science ®Google Scholar
• McPherson RA, Pincus MR, eds. Henry’s Clinical Diagnosis and Management by Laboratory Methods. 21st ed. Philadelphia: Saunders
   Google Scholar
• Noppen M, De Waele M, Li R, et al. Volume and cellular content of normal pleural fluid in humans examined by pleural lavage. Am J Respir Crit Care Med 2000;162:1023–6
   PubMedGoogle Scholar
• Porcel JM, Light RW. Diagnostic approach to pleural effusion in adults. Am Fam Physician 2006;73:1211–20
   PubMed Web of Science ®Google Scholar
• Runyon BA. Care of patients with ascites. N Engl J Med 1994;330:337–42
   PubMed Web of Science ®Google Scholar
• Hou W, Sanyal AJ. Ascites: diagnosis and management. Med Clin North Am 2009;93:801–17
   PubMed Web of Science ®Google Scholar
• Tarn AC, Lapworth R. Biochemical analysis of ascitic (peritoneal) fluid: what should we measure? Ann Clin Biochem 2010;47:397–407 [Epub 2010 Jul 1]
   Google Scholar
• Burgess LJ. Biochemical analysis of pleural, peritoneal and pericardial effusions. Clin Chim Acta 2004;343:61–84
   Google Scholar
• Lestuzzi C. Neoplastic pericardial disease: old and current strategies for diagnosis and management. World J Cardiol 2010;2:270–9
   PubMedGoogle Scholar
• Maisch B, Seferovic PM, Ristic AD, et al. Task force on the diagnosis and management of pericardial diseases of the European Society of Cardiology. Guidelines on the diagnosis and management of pericardial diseases executive summary. Eur Heart J 2004;25:587–610
   PubMed Web of Science ®Google Scholar
• Light RW, Macgregor MI, Luchsinger PC, Ball WC Jr. Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med 1972;77:507–13
   PubMed Web of Science ®Google Scholar
• Light RW. The Light criteria: the beginning and why they are useful 40 years later. Clin Chest Med 2013;34:21–6 [Epub 2013 Jan 17]
   PubMed Web of Science ®Google Scholar
• Romero-Candeira S, Hernandez L. The separation of transudates and exudates with particular reference to the protein gradient. Curr Opin Pulm Med 2004;10:294–8
   PubMed Web of Science ®Google Scholar
• Wroblewski F, Ladue JS. Lactic dehydrogenase activity in blood. Proc Soc Exp Biol Med 1955;90:210–13
   PubMed Web of Science ®Google Scholar
• Metintas M, Alatas O, Alatas F, et al. Comparative analysis of biochemical parameters for differentiation of pleural exudates from transudates Light’s criteria, cholesterol, bilirubin, albumin gradient, alkaline phosphatase, creatine kinase, and uric acid. Clin Chim Acta 1997;264:149–62
   PubMed Web of Science ®Google Scholar
• Gazquez I, Porcel JM, Vives M, et al. Comparative analysis of Light’s criteria and other biochemical parameters for distinguishing transudates from exudates. Respir Med 1998;92:762–5
   Google Scholar
• Hamm H, Brohan U, Bohmer R, Missmahl HP. Cholesterol in pleural effusions: a diagnostic aid. Chest 1987;92:296–302
   Google Scholar
• Leers MP, Kleinveld HA, Scharnhorst V. Differentiating transudative from exudative pleural effusion: should we measure effusion cholesterol dehydrogenase? Clin Chem Lab Med 2007;45:1332–8
   Google Scholar
• Porcel JM, Vives M, Vicente de Vera MC, et al. Useful tests on pleural fluid that distinguish transudates from exudates. Ann Clin Biochem 2001;38:671–5
   Google Scholar
• Romero S, Martinez A, Hernandez L, et al. Light’s criteria revisited: consistency and comparison with new proposed alternative criteria for separating pleural transudates from exudates. Respiration 2000;67:18–23
   Google Scholar
• Romero-Candeira S, Hernandez L, Romero-Brufao S, et al. Is it meaningful to use biochemical parameters to discriminate between transudative and exudative pleural effusions? Chest 2002;122:1524–9
   PubMed Web of Science ®Google Scholar
• Gil Suay V, Martinez Moragon E, Cases Viedma E, et al. Pleural cholesterol in differentiating transudates and exudates: a prospective study of 232 cases. Respiration 1995;62:57–63
   Google Scholar
• Vives M, Porcel JM, Vicente de Vera M, et al. A study of Light’s criteria and possible modifications for distinguishing exudative from transudative pleural effusions. Chest 1996;109:1503–7
   Google Scholar
• Garcia-Pachon E, Padilla-Navas I. Pleural fluid cholesterol and lactate dehydrogenase for separating exudates from transudates. Chest 1996;110:1375–6
   Google Scholar
• Kalayci AG, Gurses N, Adam B, Albayrak D. Significance of pleural fluid cholesterol and beta-2 microglobulin levels for the differentiation of pleural effusions in childhood. Clin Pediatr (Phila) 1996;35:353–8
   Google Scholar
• Meisel S, Shamiss A, Thaler M, et al. Pleural fluid to serum bilirubin concentration ratio for the separation of transudates from exudates. Chest 1990;98:141–4
   Google Scholar
• Valdes L, Pose A, Suarez J, et al. Cholesterol: a useful parameter for distinguishing between pleural exudates and transudates. Chest 1991;99:1097–102
   PubMed Web of Science ®Google Scholar
• Costa M, Quiroga T, Cruz E. Measurement of pleural fluid cholesterol and lactate dehydrogenase: a simple and accurate set of indicators for separating exudates from transudates. Chest 1995;108:1260–3
   Google Scholar
• Alexandrakis MG, Kyriakou D, Alexandraki R, et al. Pleural interleukin-1 beta in differentiating transudates and exudates: comparative analysis with other biochemical parameters. Respiration 2002;69:201–6
   Google Scholar
• Gonlugur U, Gonlugur TE. The distinction between transudates and exudates. J Biomed Sci 2005;12:985–90 [Epub 2005 Oct 14]
   Google Scholar
• Antonangelo L, Vargas FS, Acencio MM, et al. Pleural fluid: are temperature and storage time critical preanalytical error factors in biochemical analyses? Clin Chim Acta 2010;411:1275–8 [Epub 2010 May 19]
   PubMed Web of Science ®Google Scholar
• Ben-Horin S, Bank I, Shinfeld A, et al. Diagnostic value of the biochemical composition of pericardial effusions in patients undergoing pericardiocentesis. Am J Cardiol 2007;99:1294–7 [Epub 2007 Mar 19]
   Google Scholar
• Maisch B, Seferovic PM, Ristic AD, et al. Guidelines on the diagnosis and management of pericardial diseases: executive summary [Spanish]. Rev Esp Cardiol 2004;57:1090–114
   Google Scholar
• Runyon BA, Montano AA, Akriviadis EA, et al. The serum-ascites albumin gradient is superior to the exudate-transudate concept in the differential diagnosis of ascites. Ann Intern Med 1992;117:215–20
   PubMed Web of Science ®Google Scholar
• Bielsa S, Porcel JM, Castellote J, et al. Solving the Light’s criteria misclassification rate of cardiac and hepatic transudates. Respirology 2012;17:721–6
   PubMed Web of Science ®Google Scholar
• Joseph J, Badrinath P, Basran GS, Sahn SA. Is albumin gradient or fluid to serum albumin ratio better than the pleural fluid lactate dehydrogenase in the diagnostic of separation of pleural effusion? BMC Pulm Med 2002;2:1
   Google Scholar
• Atalay F, Ernam D, Hasanoglu HC, et al. Pleural adenosine deaminase in the separation of transudative and exudative pleural effusions. Clin Biochem 2005;38:1066–70 [Epub 2005 Oct 13]
   Google Scholar
• Burgess LJ, Maritz FJ, Taljaard JJ. Comparative analysis of the biochemical parameters used to distinguish between pleural transudates and exudates. Chest 1995;107:1604–9
   PubMed Web of Science ®Google Scholar
• Das AK, Baruah K. A study of significance of serum effusion albumin gradient in the differential diagnosis of pleural effusion. JK Science 2009;11:123–6
   Google Scholar
• Mangaraj M, Kumari S, Nanda R, et al. Pleural fluid MDA and serum-effusion albumin gradient in pleural effusion. Indian J Clin Biochem 2008;23:81–4 [Epub 2008 Mar 6]
   Google Scholar
• Roth BJ, O’Meara TF, Cragun WH. The serum-effusion albumin gradient in the evaluation of pleural effusions. Chest 1990;98:546–9
   PubMed Web of Science ®Google Scholar
• Sangsayunh P, Saejueng B. Benefit of serum-effusion albumin gradient in congestive heart failure patients. J Med Assoc Thai 2012;95:S6–10
   Google Scholar
• Doumas BT, Watson WA, Biggs HG. Albumin standards and the measurement of serum albumin with bromcresol green. Clin Chim Acta 1971;31:87–96
   PubMed Web of Science ®Google Scholar
• Spencer K, Price CP. Influence of reagent quality and reaction conditions on the determination of serum albumin by the bromcresol green dye-binding method. Ann Clin Biochem 1977;14:105–15
   PubMedGoogle Scholar
• Engel H, Bac DJ, Brouwer R, et al. Diagnostic analysis of total protein, albumin, white cell count and differential in ascitic fluid. Eur J Clin Chem Clin Biochem 1995;33:239–42
   PubMedGoogle Scholar
• Karatolios K, Pankuweit S, Maisch B. Diagnostic value of biochemical biomarkers in malignant and non-malignant pericardial effusion. Heart Fail Rev 2013;18:337–44
   PubMed Web of Science ®Google Scholar
• Meyers DG, Meyers RE, Prendergast TW. The usefulness of diagnostic tests on pericardial fluid. Chest 1997;111:1213–21
   PubMed Web of Science ®Google Scholar
• Ben-Horin S, Shinfeld A, Kachel E, et al. The composition of normal pericardial fluid and its implications for diagnosing pericardial effusions. Am J Med 2005;118:636–40
   Google Scholar
• Hurtado C, Chesta J. Usefulness of ascites/serum lactic dehydrogenase activity ratio in the initial approach to ascites. Arq Gastroenterol 1991;28:47–51
   Google Scholar
• Kajani MA, Yoo YK, Alexander JA, et al. Serum-ascites albumin gradients in nonalcoholic liver disease. Dig Dis Sci 1990;35:33–7
   PubMedGoogle Scholar
• Elis A, Meisel S, Tishler T, et al. Ascitic fluid to serum bilirubin concentration ratio for the classification of transudates or exudates. Am J Gastroenterol 1998;93:401–3
   Google Scholar
• Das BB, Purohit A, Acharya U, Treskova E. Serum-ascites albumin gradient: a predictor of esophageal varices with ascites. Indian J Pediatr 2001;68:511–14
   Google Scholar
• Rector WG Jr, Reynolds TB. Superiority of the serum-ascites albumin difference over the ascites total protein concentration in separation of “transudative” and “exudative” ascites. Am J Med 1984;77:83–5
   PubMed Web of Science ®Google Scholar
• Seth AK, Rangarao R, Pakhetra R, et al. Accuracy of serum: ascites albumin gradient in the aetiological diagnosis of ascites. Med J Armed Forces India 2002;58:124–6
   Google Scholar
• Boyer TD, Kahn AM, Reynolds TB. Diagnostic value of ascitic fluid lactic dehydrogenase, protein, and WBC levels. Arch Intern Med 1978;138:1103–5
   PubMedGoogle Scholar
• Khandwalla HE, Fasakin Y, El-Serag HB. The utility of evaluating low serum albumin gradient ascites in patients with cirrhosis. Am J Gastroenterol 2009;104:1401–5 [Epub 2009 Apr 21]
   Google Scholar
• Bansal S, Kaur K, Bansal AK. Diagnosing ascitic etiology on a biochemical basis. Hepatogastroenterology 1998;45:1673–7
   Google Scholar
• Lee CM, Changchien CS, Shyu WC, Liaw YF. Serum-ascites albumin concentration gradient and ascites fibronectin in the diagnosis of malignant ascites. Cancer 1992;70:2057–60
   Google Scholar
• Chen SJ, Wang SS, Lu CW, et al. Clinical value of tumour markers and serum-ascites albumin gradient in the diagnosis of malignancy-related ascites. J Gastroenterol Hepatol 1994;9:396–400
   Google Scholar
• Prieto M, Gomez-Lechon MJ, Hoyos M, et al. Diagnosis of malignant ascites: comparison of ascitic fibronectin, cholesterol, and serum-ascites albumin difference. Dig Dis Sci 1988;33:833–8
   PubMed Web of Science ®Google Scholar
• Rana SV, Babu SG, Kocchar R. Usefulness of ascitic fluid cholesterol as a marker for malignant ascites. Med Sci Monit 2005;11:CR136–42
   Google Scholar
• Villamil FG, Sorroche PB, Aziz HF, et al. Ascitic fluid alpha 1-antitrypsin. Dig Dis Sci 1990;35:1105–9
   PubMed Web of Science ®Google Scholar
• Gerbes AL, Jungst D, Xie YN, et al. Ascitic fluid analysis for the differentiation of malignancy-related and nonmalignant ascites: proposal of a diagnostic sequence. Cancer 1991;68:1808–14
   PubMed Web of Science ®Google Scholar
• Gupta R, Misra SP, Dwivedi M, et al. Diagnosing ascites: value of ascitic fluid total protein, albumin, cholesterol, their ratios, serum-ascites albumin and cholesterol gradient. J Gastroenterol Hepatol 1995;10:295–9
   PubMed Web of Science ®Google Scholar
• Castaldo G, Oriani G, Cimino L, et al. Total discrimination of peritoneal malignant ascites from cirrhosis- and hepatocarcinoma-associated ascites by assays of ascitic cholesterol and lactate dehydrogenase. Clin Chem 1994;40:478–83
   Google Scholar
• Gulyas M, Kaposi AD, Elek G, et al. Value of carcinoembryonic antigen (CEA) and cholesterol assays of ascitic fluid in cases of inconclusive cytology. J Clin Pathol 2001;54:831–5
   Google Scholar
• Cooper GR. CDC cholesterol standardization program celebrates 50 years of service. Clin Lab News 2008;34:14
   Google Scholar
• Maskell NA, Butland; Pleural Diseases Group, Standards of Care Committee, British Thoracic Society. BTS guidelines for the investigation of a unilateral pleural effusion in adults. Thorax 2003;58:ii8–17
   PubMedGoogle Scholar
• McGrath EE, Blades Z, Needham J, Anderson PB. A systematic approach to the investigation and diagnosis of a unilateral pleural effusion. Int J Clin Pract 2009;63:1653–9 [Epub 2009 Sep 16]
   Google Scholar
• Burgess LJ, Reuter H, Taljaard JJ, Doubell AF. Role of biochemical tests in the diagnosis of large pericardial effusions. Chest 2002;121:495–9
   Google Scholar
• Jungst D, Xie Y, Gerbes AL. Pathophysiology of elevated ascites fluid cholesterol in malignant ascites: increased ascites to serum relation of proteins and lipoproteins in patients with peritoneal carcinomatosis as compared to patients with cirrhosis of the liver. J Hepatol 1992;14:244–8
   Google Scholar
• Caselmann WH, Jungst D. Isolation and characterization of a cellular protein-lipid complex from ascites fluid caused by various neoplasms. Cancer Res 1986;46:1547–52
   PubMedGoogle Scholar
• Runyon BA. Management of adult patients with ascites caused by cirrhosis. Hepatology 1998;27:264–72
   PubMed Web of Science ®Google Scholar
• Jungst D, Gerbes AL, Martin R, Paumgartner G. Value of ascitic lipids in the differentiation between cirrhotic and malignant ascites. Hepatology 1986;6:239–43
   PubMed Web of Science ®Google Scholar
• Mortensen PB, Kristensen SD, Bloch A, et al. Diagnostic value of ascitic fluid cholesterol levels in the prediction of malignancy. Scand J Gastroenterol 1988;23:1085–8
   PubMed Web of Science ®Google Scholar
• Colloredo Mels G, Bellati G, Auriemma L, et al. Fibronectin, cholesterol and triglycerides ascitic fluid concentration in the prediction of malignancy. Ital J Gastroenterol 1991;23:179–86
   Google Scholar
• Runyon; AASLD Practice Guidelines Committee. Management of adult patients with ascites due to cirrhosis: an update. Hepatology 2009;49:2087–107
   Google Scholar
• Gerbes AL, Jungst D. Role of cholesterol determination in ascitic fluid analysis. Hepatology 2009;50:1320
   Google Scholar
• Darwin P, Goldberg E, Uradomo L. Jackson Pratt drain fluid-to-serum bilirubin concentration ratio for the diagnosis of bile leaks. Gastrointest Endosc 2010;71:99–104 [Epub 2009 Nov 27]
   Google Scholar
• Runyon BA. Ascitic fluid bilirubin concentration as a key to choleperitoneum. J Clin Gastroenterol 1987;9:543–5
   Google Scholar
• Garcia-Pachon E, Padilla-Navas I, Sanchez JF, et al. Pleural fluid to serum cholinesterase ratio for the separation of transudates and exudates. Chest 1996;110:97–101
   Google Scholar
• Joseph J, Badrinath P, Basran GS, Sahn SA. Is the pleural fluid transudate or exudate? A revisit of the diagnostic criteria. Thorax 2001;56:867–70
   Google Scholar
• Uzun K, Vural H, Ozer F, Imecik O. Diagnostic value of uric acid to differentiate transudates and exudates. Clin Chem Lab Med 2000;38:661–5
   Google Scholar
• Liang QL, Shi HZ, Wang K, et al. Diagnostic accuracy of adenosine deaminase in tuberculous pleurisy: a meta-analysis. Respir Med 2008;102:744–54 [Epub 2008 Jan 28]
   PubMed Web of Science ®Google Scholar
• Viljoen A, Patrick JT. In search for a better marker of acute pancreatitis: third time lucky? Clin Chem 2011;57:1471–3 [Epub 2011 Sep 15]
   PubMedGoogle Scholar
• Joseph J, Viney S, Beck P, et al. A prospective study of amylase-rich pleural effusions with special reference to amylase isoenzyme analysis. Chest 1992;102:1455–9
   Google Scholar
• Branca P, Rodriguez RM, Rogers JT, et al. Routine measurement of pleural fluid amylase is not indicated. Arch Intern Med 2001;161:228–32
   Google Scholar
• Fahim A, Kastelik JA. The utility of pleural amylase measurement in metastatic mucinous adenocarcinoma. J R Coll Physicians Edinb 2010;40:119–20
   Google Scholar
• Runyon BA. Amylase levels in ascitic fluid. J Clin Gastroenterol 1987;9:172–4
   PubMed Web of Science ®Google Scholar
• Runyon BA, Antillon MR. Ascitic fluid pH and lactate: insensitive and nonspecific tests in detecting ascitic fluid infection. Hepatology 1991;13:929–35
   PubMed Web of Science ®Google Scholar
• Hooper C, Lee YC, Maskell; BTS Pleural Guideline Group. Investigation of a unilateral pleural effusion in adults: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010;65:ii4–17
   PubMed Web of Science ®Google Scholar
• Colice GL, Curtis A, Deslauriers J, et al. Medical and surgical treatment of parapneumonic effusions: an evidence-based guideline. Chest 2000;118:1158–71; Erratum in: Chest 2001;119:319
   PubMed Web of Science ®Google Scholar
• Potts DE, Levin DC, Sahn SA. Pleural fluid pH in parapneumonic effusions. Chest 1976;70:328–31
   PubMed Web of Science ®Google Scholar
• Light RW. Management of parapneumonic effusions [editorial]. Chest 1976;70:325–6
   Google Scholar
• Sarodia BD, Goldstein LS, Laskowski DM, et al. Does pleural fluid pH change significantly at room temperature during the first hour following thoracentesis? Chest 2000;117:1043–8
   Google Scholar
• Bou-Khalil PK, Jamaleddine GW, Debek AH, El-Khatib MF. Use of heparinized versus non-heparinized syringes for measurements of the pleural fluid pH. Respiration 2007;74:659–62 [Epub 2007 Aug 3]
   Google Scholar
• Rahman NM, Mishra EK, Davies HE, et al. Clinically important factors influencing the diagnostic measurement of pleural fluid pH and glucose. Am J Respir Crit Care Med 2008;178:483–90 [Epub 2008 Jun 12]
   PubMed Web of Science ®Google Scholar
• Mishra EK, Rahman NM. Factors influencing the measurement of pleural fluid pH. Curr Opin Pulm Med 2009;15:353–7
   PubMed Web of Science ®Google Scholar
• Chandler TM, McCoskey EH, Byrd RP Jr, Roy TM. Comparison of the use and accuracy of methods for determining pleural fluid pH. South Med J 1999;92:214–17
   Google Scholar
• Cheng DS, Rodriguez RM, Rogers J, et al. Comparison of pleural fluid pH values obtained using blood gas machine, pH meter, and pH indicator strip. Chest 1998;114:1368–72
   PubMed Web of Science ®Google Scholar
• Kindig JR, Goodman MR. Clinical utility of pericardial fluid pH determination. Am J Med 1983;75:1077–9
   Google Scholar
• Wong CL, Holroyd-Leduc J, Thorpe KE, Straus SE. Does this patient have bacterial peritonitis or portal hypertension? How do I perform a paracentesis and analyze the results? JAMA 2008;299:1166–78
   PubMed Web of Science ®Google Scholar
• Gitlin N, Stauffer JL, Silvestri RC. The pH of ascitic fluid in the diagnosis of spontaneous bacterial peritonitis in alcoholic cirrhosis. Hepatology 1982;2:408–11
   PubMed Web of Science ®Google Scholar
• Scemama-Clergue J, Doutrellot-Philippon C, Metreau JM, et al. Ascitic fluid pH in alcoholic cirrhosis: a reevaluation of its use in the diagnosis of spontaneous bacterial peritonitis. Gut 1985;26:332–5
   PubMed Web of Science ®Google Scholar
• Rai RR, Acharya SK, Kambam V, et al. Evaluation of ascitic fluid polymorphonuclear count and ascitic fluid pH in early diagnosis of spontaneous bacterial peritonitis. Indian J Med Res 1988;87:600–4
   Google Scholar
• Albillos A, Cuervas-Mons V, Millan I, et al. Ascitic fluid polymorphonuclear cell count and serum to ascites albumin gradient in the diagnosis of bacterial peritonitis. Gastroenterology 1990;98:134–40
   PubMed Web of Science ®Google Scholar
• Yang CY, Liaw YF, Chu CM, Sheen IS. White count, pH and lactate in ascites in the diagnosis of spontaneous bacterial peritonitis. Hepatology 1985;5:85–90
   PubMed Web of Science ®Google Scholar
• Light RW. Clinical practice: pleural effusion. N Engl J Med 2002;346:1971–7
   PubMed Web of Science ®Google Scholar
• Heffner JE, Brown LK, Barbieri C, DeLeo JM. Pleural fluid chemical analysis in parapneumonic effusions: a meta-analysis. Am J Respir Crit Care Med 1995;151:1700–8; Erratum in: Am J Respir Crit Care Med 1995;152:823
   PubMed Web of Science ®Google Scholar
• Light RW, Girard WM, Jenkinson SG, George RB. Parapneumonic effusions. Am J Med 1980;69:507–12
   PubMed Web of Science ®Google Scholar
• Poe RH, Marin MG, Israel RH, Kallay MC. Utility of pleural fluid analysis in predicting tube thoracostomy/decortication in parapneumonic effusions. Chest 1991;100:963–7
   PubMed Web of Science ®Google Scholar
• Potts DE, Willcox MA, Good JT Jr, et al. The acidosis of low-glucose pleural effusions. Am Rev Respir Dis 1978;117:665–71
   PubMedGoogle Scholar
• Sheer TA, Runyon BA. Spontaneous bacterial peritonitis. Dig Dis 2005;23:39–46
   Google Scholar
• Runyon BA, Hoefs JC. Ascitic fluid analysis in the differentiation of spontaneous bacterial peritonitis from gastrointestinal tract perforation into ascitic fluid. Hepatology 1984;4:447–50
   PubMed Web of Science ®Google Scholar
• Wilson JA, Suguitan EA, Cassidy WA, et al. Characteristics of ascitic fluid in the alcoholic cirrhotic. Dig Dis Sci 1979;24:645–8
   PubMed Web of Science ®Google Scholar
• Gold P, Freedman SO. Specific carcinoembryonic antigens of the human digestive system. J Exp Med 1965;122:467–81
   PubMed Web of Science ®Google Scholar
• Gold P, Freedman SO. Demonstration of tumor-specific antigens in human colonic carcinomata by immunological tolerance and absorption techniques. J Exp Med 1965;121:439–62
   PubMed Web of Science ®Google Scholar
• Perkins GL, Slater ED, Sanders GK, Prichard JG. Serum tumor markers. Am Fam Physician 2003;68:1075–82
   PubMed Web of Science ®Google Scholar
• Alatas F, Alatas O, Metintas M, et al. Diagnostic value of CEA, CA 15-3, CA 19-9, CYFRA 21-1, NSE and TSA assay in pleural effusions. Lung Cancer 2001;31:9–16
   PubMed Web of Science ®Google Scholar
• Porcel JM, Vives M, Esquerda A, et al. Use of a panel of tumor markers (carcinoembryonic antigen, cancer antigen 125, carbohydrate antigen 15–3, and cytokeratin 19 fragments) in pleural fluid for the differential diagnosis of benign and malignant effusions. Chest 2004;126:1757–63
   PubMed Web of Science ®Google Scholar
• Ustun H, Borazan A, Bilgicli N, Yilmaz A. Diagnostic value of tumoural markers in pleural effusions. Int J Clin Pract 2004;58:22–5
   Google Scholar
• Shitrit D, Zingerman B, Shitrit AB, et al. Diagnostic value of CYFRA 21-1, CEA, CA 19-9, CA 15-3, and CA 125 assays in pleural effusions: analysis of 116 cases and review of the literature. Oncologist 2005;10:501–7
   PubMed Web of Science ®Google Scholar
• Villena V, Lopez-Encuentra A, Echave-Sustaeta J, et al. Diagnostic value of CA 72-4, carcinoembryonic antigen, CA 15-3, and CA 19-9 assay in pleural fluid: a study of 207 patients. Cancer 1996;78:736–40
   PubMedGoogle Scholar
• Wagner IC, Guimaraes MJ, da Silva LK, et al. Evaluation of serum and pleural levels of the tumor markers CEA, CYFRA21-1 and CA 15-3 in patients with pleural effusion. J Bras Pneumol 2007;33:185–91 [English, Portuguese]
   Google Scholar
• Gaspar MJ, De Miguel J, Garcia Diaz JD, Diez M. Clinical utility of a combination of tumour markers in the diagnosis of malignant pleural effusions. Anticancer Res 2008;28:2947–52
   PubMed Web of Science ®Google Scholar
• Korczynski P, Krenke R, Safianowska A, et al. Diagnostic utility of pleural fluid and serum markers in differentiation between malignant and non-malignant pleural effusions. Eur J Med Res 2009;14:128–33
   Google Scholar
• Hackbarth JS, Murata K, Reilly WM, Algeciras-Schimnich A. Performance of CEA and CA19–9 in identifying pleural effusions caused by specific malignancies. Clin Biochem 2010;43:1051–5 [Epub 2010 Jun 8]
   Google Scholar
• Sthaneshwar P, Yap SF, Jayaram G. The diagnostic usefulness of tumour markers CEA and CA-125 in pleural effusion. Malays J Pathol 2002;24:53–8
   Google Scholar
• Lee JH, Chang JH. Diagnostic utility of serum and pleural fluid carcinoembryonic antigen, neuron-specific enolase, and cytokeratin 19 fragments in patients with effusions from primary lung cancer. Chest 2005;128:2298–303
   PubMed Web of Science ®Google Scholar
• Torresini RJ, Prolla JC, Diehl AR, et al. Combined carcinoembryonic antigen and cytopathologic examination in ascites. Acta Cytol 2000;44:778–82
   Google Scholar
• Sari R, Yildirim B, Sevinc A, et al. The importance of serum and ascites fluid alpha-fetoprotein, carcinoembryonic antigen, CA 19-9, and CA 15-3 levels in differential diagnosis of ascites etiology. Hepatogastroenterology 2001;48:1616–21
   Google Scholar
• Tuzun Y, Celik Y, Bayan K, et al. Correlation of tumour markers in ascitic fluid and serum: are measurements of ascitic tumour markers a futile attempt? J Int Med Res 2009;37:79–86
   Google Scholar
• Kaleta EJ, Tolan NV, Ness KA, et al. CEA, AFP and CA 19–9 analysis in peritoneal fluid to differentiate causes of ascites formation. Clin Biochem 2013;46:814–18 [Epub 2013 Feb 27]
   Google Scholar
• Lee IK, Kim do H, Gorden DL, et al. Prognostic value of CEA and CA 19-9 tumor markers combined with cytology from peritoneal fluid in colorectal cancer. Ann Surg Oncol 2009;16:861–70 [Epub 2009 Feb 3]
   Google Scholar
• Jung M, Jeung HC, Lee SS, et al. The clinical significance of ascitic fluid CEA in advanced gastric cancer with ascites. J Cancer Res Clin Oncol 2010;136:517–26 [Epub 2009 Sep 23]
   Web of Science ®Google Scholar
• Prakash UB, Reiman HM. Comparison of needle biopsy with cytologic analysis for the evaluation of pleural effusion: analysis of 414 cases. Mayo Clin Proc 1985;60:158–64
   PubMed Web of Science ®Google Scholar
• Garrison RN, Kaelin LD, Galloway RH, Heuser LS. Malignant ascites: clinical and experimental observations. Ann Surg 1986;203:644–51
   PubMed Web of Science ®Google Scholar
• Tomb J. A cytopathological study on serous fluid in cancer. J Med Liban 1974;27:51–8
   PubMedGoogle Scholar
• Villena V, Lopez-Encuentra A, Echave-Sustaeta J, et al. Diagnostic value of CA 549 in pleural fluid: comparison with CEA, CA 15.3 and CA 72.4. Lung Cancer 2003;40:289–94
   Google Scholar
• Tatsuta M, Yamamura H, Yamamoto R, et al. Carcinoembryonic antigens in the pericardial fluid of patients with malignant pericarditis. Oncology 1984;41:328–30
   Google Scholar
• Szturmowicz M, Tomkowski W, Fijalkowska A, et al. Diagnostic utility of CYFRA 21-1 and CEA assays in pericardial fluid for the recognition of neoplastic pericarditis. Int J Biol Markers 2005;20:43–9
   Google Scholar
• Szturmowicz M, Tomkowski W, Fijalkowska A, et al. 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 1997;12:96–101
   Google Scholar
• Steinberg W. The clinical utility of the CA 19-9 tumor-associated antigen. Am J Gastroenterol 1990;85:350–5
   PubMed Web of Science ®Google Scholar
• Li CS, Cheng BC, Ge W, Gao JF. Clinical value of CYFRA21-1, NSE, CA15-3, CA19-9 and CA125 assay in the elderly patients with pleural effusions. Int J Clin Pract 2007;61:444–8
   Google Scholar
• Tuzun Y, Yilmaz S, Dursun M, et al. How to increase the diagnostic value of malignancy-related ascites: discriminative ability of the ascitic tumour markers. J Int Med Res 2009;37:87–95
   Google Scholar
• Molina R, Filella X, Jo J, et al. CA 125 in biological fluids. Int J Biol Markers 1998;13:224–30
   Google Scholar
• Buccheri G, Ferrigno D. Cytokeratin-derived markers of lung cancer. Expert Rev Mol Diagn 2001;1:315–22
   PubMedGoogle Scholar
• Toumbis M, Rasidakis A, Passalidou E, et al. Evaluation of CYFRA 21-1 in malignant and benign pleural effusions. Anticancer Res 1996;16:2101–4
   PubMed Web of Science ®Google Scholar
• Suzuki H, Hirashima T, Kobayashi M, et al. Cytokeratin 19 fragment/carcinoembryonic antigen ratio in pleural effusion is a useful marker for detecting malignant pleural mesothelioma. Anticancer Res 2010;30:4343–6
   Google Scholar
• Bielsa S, Esquerda A, Salud A, et al. High levels of tumor markers in pleural fluid correlate with poor survival in patients with adenocarcinomatous or squamous malignant effusions. Eur J Intern Med 2009;20:383–6 [Epub 2008 Dec 21]
   Google Scholar
• Duffy MJ, Evoy D, McDermott EW. CA 15-3: uses and limitation as a biomarker for breast cancer. Clin Chim Acta 2010;411:1869–74 [Epub 2010 Sep 8]
   PubMed Web of Science ®Google Scholar
• Miedouge M, Salama G, Barange K, et al. Evaluation of alpha-fetoprotein assay in ascitic fluid for the diagnosis of hepatocellular carcinoma. Clin Chim Acta 1999;280:161–71
   Google Scholar
• Gillery P, Bajolet O, Rouzaud E, et al. Is assay of alpha-fetoprotein in ascitic fluid of clinical interest? Clin Chem 1986;32:1592
   Google Scholar
• Porcel JM, Chorda J, Cao G, et al. Comparing serum and pleural fluid pro-brain natriuretic peptide (NT-proBNP) levels with pleural-to-serum albumin gradient for the identification of cardiac effusions misclassified by Light’s criteria. Respirology 2007;12:654–9
   Google Scholar
• Porcel JM. Pleural effusions from congestive heart failure. Semin Respir Crit Care Med 2010;31:689–97 [Epub 2011 Jan 6]
   PubMed Web of Science ®Google Scholar