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Test ID: PFCEA Carcinoembryonic Antigen (CEA), Pleural Fluid

Reporting Name

CEA, Pleural Fluid

Useful For

An adjuvant to cytology and imaging studies to differentiate between nonmalignant and malignant causes of pleural effusions

Specimen Type

Pleural Fluid

Specimen Required

Container/Tube: Plain, plastic, screw-top tube

Specimen Volume: 2 mL

Specimen Minimum Volume

0.5 mL (Specimens <0.5 mL may be rejected)

Specimen Stability Information

Specimen Type Temperature Time
Pleural Fluid Frozen (preferred) 90 days
  Refrigerated  14 days
  Ambient  7 days

Reference Values

An interpretive report will be provided.

Day(s) and Time(s) Performed

Monday through Friday; Varies

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.

CPT Code Information


LOINC Code Information

Test ID Test Order Name Order LOINC Value
PFCEA CEA, Pleural Fluid 19168-4


Result ID Test Result Name Result LOINC Value
PCEA CEA, Pleural Fluid 19168-4
SITE9 Site 39111-0

Clinical Information

Pleural effusions occur as a consequence of either nonmalignant conditions (including congestive heart failure, pneumonia, pulmonary embolism, and liver cirrhosis) or malignant conditions (including lung, breast, and lymphoma cancers). Diagnosing the cause of an effusion can be difficult, often requiring cytological examination of the pleural fluid and imaging studies of the pleural tissue. Analysis of various tumor markers in pleural fluid has shown that these markers can differentiate between effusions caused by nonmalignant and malignant conditions and can enhance cytology and imaging findings.


Carcinoembryonic antigen (CEA) is a glycoprotein produced during fetal development. Nonsmoking, healthy adults typically produce low to undetectable levels of CEA. Serum concentrations of CEA may be elevated in patients with certain malignancies that secrete CEA into circulation, including medullary thyroid carcinoma and breast, gastrointestinal tract, colorectal, liver, lung, ovarian, pancreatic, and prostate cancers.


Pleural fluid concentrations of CEA have been reported to be elevated in patients with certain malignancies. Malignancies that can secrete CEA and elevate serum CEA concentrations, including lung, breast, ovarian, gastrointestinal, and colorectal cancers, typically also elevate CEA in pleural fluid. In contrast, malignancies that do not secrete CEA, including mesothelioma, lymphoma, leukemia, and melanoma, have low concentrations of CEA in pleural fluid comparable to concentrations observed in non-malignant effusions.


Elevated CEA concentrations in pleural fluid have also been reported with certain nonmalignant conditions, including liver cirrhosis, pancreatitis, complicated parapneumonic effusions and empyemas, and rarely with tuberculosis.


CEA results should be used in conjunction with cytological analysis of pleural fluid, imaging studies, and other clinical findings.


A pleural fluid carcinoembryonic antigen (CEA) concentration of 3.5 ng/mL or higher is suspicious but not diagnostic of a malignant source of the effusion. This cutoff yielded a sensitivity of 52%, specificity of 95%, and part per volume of 93% in a study of 200 patients presenting with effusion. CEA concentrations were significantly higher in effusions caused by CEA-secreting malignancies, including lung, breast, ovarian, gastrointestinal, and colorectal cancers. However, effusions caused by non-CEA-secreting malignancies, including lymphoma, mesothelioma, leukemia, and melanoma, routinely had CEA concentrations below 3.5 ng/mL. Therefore, negative results should be interpreted with caution, especially in patients who have or are suspected of having a non-CEA-secreting malignancy.


Correlation of all tumor marker results with cytology and imaging is highly recommended.

Clinical Reference

1. 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;10:501-507

2. Hackbarth JS, Murata K, Reilly W, Algeciras-Schimnich A: Performance of CEA and CA19-9 in identifying pleural effusions caused by specific malignancies. Clin Biochem 2010 Sep;43(13-14):1051-1055

3. Garcia-Pachon E, Padilla-Navas I, Dosda MD, Miralles-Llopis A: Elevated level of carcinoembryonic antigen in nonmalignant pleural effusions. Chest 1997;111:643-647

Analytic Time

Same day/1 day

Method Name

Immunoenzymatic Assay

Mayo Clinic Laboratories | Oncology Catalog Additional Information: