J Clin Neurol.  2010 Mar;6(1):33-37. 10.3988/jcn.2010.6.1.33.

Diagnostic Value of Cerebrospinal Fluid Level of Carcinoembryonic Antigen in Patients with Leptomeningeal Carcinomatous Metastasis

• Kang SJ
• Kim KS
• Ha YS
• Huh SY
• Lee JH
• Kim JK
• Kim MJ

• KMID: 2135479
• DOI: http://doi.org/10.3988/jcn.2010.6.1.33

Abstract

BACKGROUND AND PURPOSE
Multifocal seeding of the leptomeninges by malignant cells, which is usually referred to as leptomeningeal carcinomatous metastasis, produces substantial morbidity and mortality. The diagnosis of leptomeningeal metastasis is usually established by cerebrospinal fluid (CSF) investigation, including cytology, cell counts, protein, glucose, and a tumor marker such as carcinoembryonic antigen (CEA). This study examined the diagnostic value of CEA in the CSF.
METHODS
We measured the CSF CEA level in 32 patients with leptomeningeal metastasis. The control group consisted of 19 cancer patients without leptomeningeal metastasis. CEA was measured by the chemiluminescent emission method.
RESULTS
The CEA level was significantly higher in patients with leptomeningeal metastasis than in the control group (p<0.005). The level of CSF protein was higher and that of CSF glucose was lower in patients with leptomeningeal metastasis than in the control group (p<0.005).
CONCLUSIONS
The CSF CEA level is useful for diagnosing leptomeningeal carcinomatous metastasis. The CSF levels of protein and glucose are also useful in the diagnosis.

Keyword

leptomeningeal metastasis; carcinoembryonic antigen; cerebrospinal fluid

MeSH Terms

Carcinoembryonic Antigen
Cell Count
Glucose
Humans
Neoplasm Metastasis
Seeds
Carcinoembryonic Antigen
Glucose

Figure

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  Fig. 1 Comparison of cerebrospinal fluid (CSF) carcinoembryonic antigen (CEA) level between cancer patients with and without leptomeningeal carcinomatous metastasis. The CSF CEA level was significantly higher in patients with leptomeningeal metastasis. Data are mean and SD values. *p=0.002.

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  Fig. 2 Relation between CSF and serum CEA levels in the metastasis group. The CSF-to-serum ratio is about 1:1. CEA: carcinoembryonic antigen.

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  Fig. 3 Relation between CSF and serum CEA levels in the control group. The CEA level exceeded 5 ng/mL in only 1 of the 19 patients, and the CSF-to-serum CEA ratio was nearly 1 : 60. This suggests that CSF CEA comes from serum CEA passing through the blood-brain barrier. CEA: carcinoembryonic antigen.

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  Fig. 4 Comparison of CSF glucose level between patients with and without leptomeningeal metastasis. The CSF glucose level was significantly lower in patients with leptomeningeal metastasis. Data are mean and SD values. *p=0.011.

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  Fig. 5 Comparison of CSF protein level between patients with and without leptomeningeal metastasis. The CSF protein was significantly higher in patients with leptomeningeal metastasis. Data are mean and SD values. *p=0.002.

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