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Relative Operating Characteristic Analysis and Group Modeling for Tumor Markers: Comparison of CA 15.3, Carcinoembryonic Antigen, and Mucin-like Carcinoma-associated Antigen in Breast Carcinoma

Department of Advanced Therapeutics [H. K. B., S., B-L. A.], Division of Medical Oncology [J. R.], and Division of Epidemiology, Biometry and Occupational Oncology [A. J. C.], British Columbia Cancer Agency, Vancouver, British Columbia, Canada

Relative operating characteristic (ROC) analysis was used to examine the clinical applicability of 3 breast carcinoma tumor markers, CA 15.3, carcinoembryonic antigen, and mucin-like carcinoma-associated antigen. Each tumor marker was quantitated in single serum samples collected from 100 normal blood donors, 60 patients with nonmalignant diseases, 33 women at high risk for breast carcinoma, 30 patients with malignancies other than breast carcinoma, and 158 breast carcinoma patients including 67 with no evidence of disease following surgery, 46 with a tumor burden <5 g, and 45 with a tumor burden >5 g. These were used to construct models for early diagnosis among those at high risk for breast carcinoma, the influence of nonmalignant disease on early diagnosis, discrimination of breast carcinoma from other adenocarcinomas, detection of early recurrence, and assessment of change in tumor burden. For each model ROC data permitted the unbiased selection of the most appropriate critical values based on the interaction of sensitivity and specificity. ROC analysis indicated that in practice the assays were remarkably similar. While CA 15.3 generally performed best, there was significant variation among models. Optimal marker selection can thus depend on specific clinical application. In some cases ROC identified a combination of markers as superior to any single assay, but this was not statistically significant.

¹ To whom requests for reprints should be addressed, at the British Columbia Cancer Agency, 600 West 10th Avenue, Vancouver, British Columbia, Canada, V5Z 4E6.

Received 8/13/90. Accepted 1/22/91.

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