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Meta-Analysis
. 2021 Dec;53(1):558-566.
doi: 10.1080/07853890.2021.1906943.

Diagnostic accuracy of the cancer ratio for the prediction of malignant pleural effusion: evidence from a validation study and meta-analysis

Ying Zhang  1   2 , Xiaoou Li  1   2 , Junhui Liu  1   2 , Xueru Hu  1   2 , Chun Wan  1   2 , Rui Zhang  3 , Yongchun Shen  1   2
Affiliations
Meta-Analysis

Diagnostic accuracy of the cancer ratio for the prediction of malignant pleural effusion: evidence from a validation study and meta-analysis

Ying Zhang et al. Ann Med. 2021 Dec.

Abstract

Objective: This 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.

Methods: We 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.

Results: Significantly 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.

Conclusion: CR has a high diagnostic accuracy for predicting MPE, especially when used in combination with pleural CEA.

Keywords: Malignant pleural effusion; cancer ratio; carcinoembryonic antigen; diagnosis; meta-analysis.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Receiver operating characteristic curves showing the performance of the cancer ratio and levels of carcinoembryonic antigen for diagnosing MPE.
Figure 2.
Figure 2.
Flow diagram of study selection in the meta-analysis.
Figure 3.
Figure 3.
Quality assessment of studies included in the meta-analysis.
Figure 4.
Figure 4.
Forest plots of (a) sensitivity and (b) specificity of the cancer ratio for diagnosing MPE, along with 95% confidence intervals (CIs).
Figure 5.
Figure 5.
Summary receiver operating characteristic curve assessing the performance of the cancer ratio for diagnosing MPE.
Figure 6.
Figure 6.
Deek’s funnel plot to assess risk of publication bias in the meta-analysis of the performance of the cancer ratio for diagnosing MPE.
See this image and copyright information in PMC

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