Test ID: CEAPT
Carcinoembryonic Antigen (CEA), Peritoneal Fluid
NY State Approved 
Indicates the status of NY State approval and if the test is orderable for NY State clients.
Useful For Suggests clinical disorders or settings where the test may be helpful
An adjunct to cytology to differentiate between malignancy-related and benign causes of ascites formation
Method Name A short description of the method used to perform the test
Immunoenzymatic Assay
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Aliases Lists additional common names for a test, as an aid in searching
CEA Paracentesis Fluid
CEA Ascites Fluid
CEA Abdominal Fluid
Specimen Type Describes the specimen type needed for testing
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
Collection Container/Tube: Body fluid container
Submission Container/Tube: Plastic vial
Specimen Volume: 2 mL
Specimen Minimum Volume Defines the amount of specimen required to perform an assay once, including instrument and container dead space. Submitting the minimum specimen volume makes it impossible to repeat the test or perform confirmatory or perform reflex testing. In some situations, a minimum specimen volume may result in a QNS (quantity not sufficient) result, requiring a second specimen to be collected.
Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected
| Hemolysis | NA |
| Lipemia | NA |
| Icterus | NA |
| Other | NA |
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
| Specimen Type | Temperature | Time |
|---|---|---|
| Peritoneal | Frozen (preferred) | 90 days |
| Ambient | 7 days | |
| Refrigerated | 7 days |
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Malignancy accounts for approximately 7% of cases of ascites formation. Malignant disease can cause ascites by various mechanisms including: peritoneal carcinomatosis (53%), massive liver metastasis causing portal hypertension (13%), peritoneal carcinomatosis plus massive liver metastasis (13%), hepatocellular carcinoma plus cirrhosis (7%), and chylous ascites due to lymphoma (7%). The evaluation and diagnosis of malignancy-related ascites is based on the patient clinical history, ascites fluid analysis, and imaging tests.
The overall sensitivity of cytology for the detection of malignancy-related ascites ranges from 58% to 75%. Cytology examination is most successful in patients with ascites related to peritoneal carcinomatosis as viable malignant cells are exfoliated into the ascitic fluid. However, only approximately 53% of patients with malignancy-related ascites have peritoneal carcinomatosis. Patients with other causes of malignancy-related ascites almost always have a negative cytology.
Carcinoembryonic antigen (CEA) is a glycoprotein that is shed from the surface of malignant cells. Measurement of CEA in ascitic fluid has been proposed as a helpful test in detecting malignancy-related ascites given the limited sensitivity of cytology.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
An interpretive report will be provided.
Interpretation Provides information to assist in interpretation of the test results
A peritoneal fluid carcinoembryonic antigen (CEA) concentration >6.0 ng/mL is suspicious but not diagnostic of malignancy-related ascites. This clinical decision limit cutoff yielded 48% sensitivity and 99% specificity in a study of 137 patients presenting with ascites. CEA concentrations were significantly higher in ascites caused by malignancies known to be associated with elevated serum CEA levels including lung, breast, ovarian, gastrointestinal, and colorectal cancers. However, ascites caused by other malignancies such as lymphoma, mesothelioma, leukemia, and melanoma and hepatocellular carcinoma, routinely had CEA concentrations <6.0 ng/mL. Therefore, negative results should be interpreted with caution, especially in patients who have or are suspected of having a malignancy not associated with elevated CEA levels in serum.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Do not use peritoneal fluid carcinoembryonic antigen (CEA) concentration as absolute evidence of the presence or the absence of malignant disease. The CEA result should be interpreted in conjunction with information from the clinical evaluation of the patient and other diagnostic procedures.
Immunometric assays can, in rare occasions, be subject to interferences such as "hooking" at very high analyte concentrations (false-low results) and heterophilic antibody interference (false-high results). If the clinical picture does not fit the laboratory result, these possibilities should be considered.
CEA values are method-dependent; therefore, the same method should be used if patients are serially monitored.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Torresini RJ, Prolla JC, Diehl AR, et al: Combined carcinoembryonic antigen and cytopathologic examination in ascites. Acta Cytol 2000;44(5):778-782
2. 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(1):87-95
Method Description Describes how the test is performed and provides a method-specific reference
The instrument used is Beckman Coulter UniCel DXI 800. The Access CEA assay is a 2-site immunoenzymatic sandwich assay using mouse monoclonal anti- carcinoembryonic antigen (CEA) antibodies that react with different epitopes of CEA. A sample is added to a reaction vessel, along with the first anti-CEA monoclonal antibodies-alkaline phosphatase conjugate and the second anti-CEA monoclonal antibodies bound to paramagnetic particles. The incubation is followed by a magnetic separation and washing. The chemiluminescent substrate Lumi-Phos 530 is added to the vessel and light generated by the reaction is measured with a luminometer. The light production is proportional to the concentration of CEA in the sample. The amount of analyte in the sample is determined by means of a stored, multipoint calibrator curve.(Package insert: Beckman Coulter, Inc, Fullerton, CA, 2007)
For all samples with CEA concentrations >3 ng/mL, a dilution series is performed. A linear dilution excludes hooking and most major interferences. Samples that contain CEA concentrations < or =3 ng/mL are spiked with exogenous CEA to identify possible interferences that may cause a false-low result.
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
Monday through Friday; Varies
Analytic Time Defines the amount of time it takes the laboratory to setup and perform the test. This is defined in number of days. The shortest interval of time expressed is "same day/1 day," which means the results may be available the same day that the sample is received in the testing laboratory. One day means results are available 1 day after the sample is received in the laboratory.
Maximum Laboratory Time Defines the maximum time from specimen receipt at Mayo Medical Laboratories until the release of the test result
Specimen Retention Time Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location The location of the laboratory that performs the test
Test Classification Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer's instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR), Investigation Use Only (IUO) product, or a Research Use Only (RUO) product.
CPT Code Information Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
82378
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
| Result ID | Reporting Name | LOINC Code |
|---|---|---|
| CEAPN | CEA, Peritoneal Fluid | N/A |
| SITED | Site | N/A |
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