Pleural Fluid Mesothelin as an Adjunct to the Diagnosis of Pleural Malignant Mesothelioma

30/03/2016
Author:  Jenette Creaney; Amanda Segal; Nola Olsen; Ian M. Dick; A. W(Bill) Musk; Steven J. Skates and Bruce W. Robinson

Jenette Creaney, Amanda Segal,  Nola Olsen,  Ian M. Dick, A. W(Bill) Musk, Steven J. Skates, and Bruce W. Robinson. 
Disease Markers Volume 2014, Article ID 413946 - http://dx.doi.org/10.1155/2014/413946

Rationale

The diagnosis of pleural malignant mesothelioma (MM) by effusion cytology may be difficult and is currently controversial. Effusion mesothelin levels are increased in patients with MM but the clinical role of this test is uncertain.

Objectives

To determine the clinical value of measuring mesothelin levels in pleural effusion supernatant to aid diagnosis of MM. Methods and Measurements. Pleural effusion samples were collected prospectively from 1331 consecutive patients. Mesothelin levels were determined by commercial ELISA in effusions and their relationship to concurrent pathology reporting and final clinical diagnosis was determined.

Results

2156 pleural effusion samples from1331 individuals were analysed. The final clinical diagnosis was 183 MM, 436 non-MM malignancy, and 712 nonmalignant effusions. Effusion mesothelin had a sensitivity of 67% for MM at 95% specificity.  Mesothelin was elevated in over 47% of MM cases in effusions obtained before definitive diagnosis of MM was established. In the setting of inconclusive effusion cytology, effusion mesothelin had a positive predictive value of 79% for MM and 94% for malignancy.

Conclusions

A mesothelin-positive pleural effusion, irrespective of the identification of malignant cells, indicates the likely presence of malignancy and adds weight to the clinical rationale for further investigation to establish a malignant diagnosis.

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