The tissue polypeptide antigen serum test in the preoperative evaluation of XXXX . Diagnostic yield and comparison with conventional staging methods.

@entity5 @entity1 @entity1149 @entity865
Tissue polypeptide antigen ( @entity865 ) is a protein produced and released by proliferating cells that has been shown to possess several characteristics for an ideal @entity5 marker. Our purpose was to determine the yield of @entity865 in the pretreatment assessment of @entity1149 ( @entity1149 ), in comparison with a baseline clinical evaluation and multiorgan computed tomography (CT) assumed to be the gold standard for presurgical staging. One hundred four @entity1 with @entity1149 underwent thoracotomy, mediastinoscopy, or biopsy of suspected metastatic deposits, in addition to an extensive noninvasive evaluation of their stage of disease. We restaged retrospectively (UICC 1987 classification) these @entity1 , on the basis of the following: (1) clinical history and physical examination, routine laboratory tests, bronchoscopy, chest radiographs, and any other examination as indicated by the prior baseline evaluation (BE stage); (2) the serum level of @entity865 ( @entity865 stage); (3) the reading of a CT scan of brain, thorax, and abdomen obtained with no limitation to clinical information (CT stage); and (4) pathologic findings (RE stage). The @entity865 stage was calculated using 20 threshold values ranging from 45 U/L to 450 U/L. On the basis of the RE stage, sensitivity, specificity, accuracy, and predictive capabilities of BE, CT, and @entity865 were determined for stage I and II (full operability, FO), stage IIIa (possible operability, PO), and stage IIIb and IV (full inoperability, FI). The @entity865 thresholds were 110 U/L for detecting FO with the highest rate of success, and 160 U/L for detecting FI. Using these thresholds BE, CT, and @entity865 showed a diagnostic accuracy of, respectively, 75%, 79%, and 68% for FO; 87%, 69%, and 77% for PO; 87%, 77%, and 76% for FI. The accuracy of BE, CT, and @entity865 for both FO and FI was, respectively, 85%, 69%, and 69%. Of 74 @entity1 classified operable by BE, 6 had a serum concentration of @entity865 less than 50 U/L and all 6 were confirmed in stage I or II at the subsequent thoracotomy; 15 others, out of 26 @entity1 judged to have inoperable conditions by BE, had a @entity865 test result above 135 U/L and all 15 were pathologically classified in stage IIIb or IV. Using appropriate threshold values of @entity865 , it should be possible to predict @entity1149 resectability with a diagnostic accuracy similar to that routinely achieved by CT.
