Skip to main content

Advertisement

Log in

Clinical value of mesothelin in pleural effusions versus histology by medical thoracoscopy: brief report

  • Original Paper
  • Published:
Medical Oncology Aims and scope Submit manuscript

Abstract

The aim of this study based on the third phase of the architecture of diagnostic research was to assess the sensitivity and specificity of soluble mesothelin-related peptide (SMRP) in pleural exudative effusions (PE) compared to the histology obtained by medical thoracoscopy as the diagnostic gold standard examination. We assessed 104 consecutive thoracoscopies. SMRP concentrations were obtained using an ELISA test. We had 34 mesotheliomas (25 epithelioid and 9 sarcomatoid), 35 pleural metastases, and 35 benign diseases. PE-SMRP were significantly higher in patients with epitheliomorphic mesothelioma (mean ± SD 46.55 ± 44.29 nM) than in patients with sarcomatoid mesothelioma (16.11 ± 25.02 nM; p = 0.061), pleural metastasis (7.52 ± 10.77 nM; p < 0.0001), or benign diseases (5.82 ± 8.86 nM; p < 0.0001). Using ROC curve analysis, PE-SMRP offered an AUC of 0.767 in its ability to differentiate between patients with mesothelioma and all other diagnoses. The diagnostic sensitivity and specificity of PE-SMRP for distinguishing mesothelioma from all other causes of pleural effusion, at a cut-off value of 19.6 nM, were 58.8 and 97.1 %, respectively. PE-SMRP higher than the assumed cut-off of 19.6 nM were observed in 18/25 (72.0 %) epitheliomorphic mesotheliomas, 2/9 (22.2 %) sarcomatoid mesotheliomas, 5/35 (14.3 %) pleural metastases, and 1/35 (2.9 %) benign diseases. We conclude that PE-SMRP adds some clinical information in the work-up of patients with a PE of unknown origin: (1) thoracoscopy should always be done in patients with a positive mesothelin; (2) a negative mesothelin does not exclude a malignant disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Rahman NM, Ali NJ, Brown G, Chapman SJ, Davies RJO, Downer NJ, Gleeson FV, Howes TQ, Treasure T, Singh S, Phillips GD. On behalf of the British thoracic society pleural disease guideline group. Local anaesthetic thoracoscopy: British thoracic society pleural disease guideline 2010. Thorax. 2010;65:ii54–60.

    Article  PubMed  Google Scholar 

  2. Rakha EA, Patil S, Abdulla K, Abdulkader M, Chaudry Z, Soomro IN. The sensitivity of cytologic evaluation of pleural fluid in the diagnosis of malignant mesothelioma. Diagn Cytopathol. 2010;38(12):874–9.

    Article  PubMed  CAS  Google Scholar 

  3. Bielsa S, Panades MJ, Egido R, Rue M, Salud A, Matias-Guiu X, Rodriguez-Panadero F, Porcel JM. Rentabilidad del estudio citologico del liquido pleural en el derrame maligno. An Med Interna (Madrid). 2008;25(4):173–7.

    Article  CAS  Google Scholar 

  4. Filiberti R, Parodi S, Libener R, Ivaldi GP, Canessa PA, Ugolini D, Bobbio B, Marroni P. Diagnostic value of mesothelin in pleural fluids: comparison with CYFRA 21–1 and CEA. Med Oncol. 2013;30(2):543–52.

    Article  PubMed  Google Scholar 

  5. Porcel JM, Vives M, Esquerda A, Salud A, Perez B, Rodrıguez-Panadero F. Use of a panel of tumor markers (carcinoembryonic antigen, cancer antigen 125, carbohydrate antigen 15–3, and cytokeratin 19 fragments) in pleural fluid for the differential diagnosis of benign and malignant effusions. Chest. 2004;126:1757–63.

    Article  PubMed  Google Scholar 

  6. Canessa PA, Manta C, Ferro P, Franceschini MC, Sivori M, Fontana V, Fedeli F, Pistillo MP, Roncella S. Clinical relevance of human mammaglobin mRNA in pleural effusion from patients undergoing thoracoscopy: a pilot study. Int J Biol Markers. 2012;27(2):99–104.

    Article  Google Scholar 

  7. Ordonez NG. Value of mesothelin immunostaining in the diagnosis of mesothelioma. Mod Pathol. 2003;16:192–7.

    Article  PubMed  Google Scholar 

  8. Creaney J, Francis RJ, Dick IM, Musk AW, Robinson BW, Byrne MJ, Nowak AK. Serum soluble mesothelin concentrations in malignant pleural mesothelioma: relationship to tumor volume, clinical J stage and changes in tumor burden. Clin Cancer Res. 2011;17:1181–9.

    Article  PubMed  CAS  Google Scholar 

  9. Cristaudo A, Foddis R, Vivaldi A, Guglielmi G, Dipalma N, Filiberti R, Neri M, Ceppi M, Paganuzzi M, Ivaldi GP, Mencoboni M, Canessa PA, Ambrosino N, Chella A, Mutti L, Puntoni R. Clinical significance of serum mesothelin in patients with mesothelioma and lung cancer. Clin Cancer Res. 2007;13:5076–81.

    Article  PubMed  CAS  Google Scholar 

  10. Yamada S, Tabata C, Tabata R, Fukuoka K, Nakano T. Clinical significance of pleural effusion mesothelin in malignant pleural mesothelioma. Clin Chem Lab Med. 2011;49:1721–6.

    Article  PubMed  CAS  Google Scholar 

  11. Creaney J, Yeoman D, Naumoff LK, Hof M, Segal A, Musk AW, De Klerk N, Horick N, Skates SJ, Robinson BW, Naumoff NK, et al. Soluble mesothelin in effusions: a useful tool for the diagnosis of malignant mesothelioma. Thorax. 2007;62:569–76.

    Article  PubMed  Google Scholar 

  12. Davies HE, Sadler RS, Bielsa S, Maskell NA, Rahman NM, Davies RJ, Ferry BL, Lee YC. Clinical impact and reliability of pleural fluid mesothelin in undiagnosed pleural effusions. Am J Respir Crit Care Med. 2009;180:437–44.

    Article  PubMed  Google Scholar 

  13. Canessa PA, Franceschini MC, Ferro P, Battolla E, Dessanti P, Manta C, Sivori M, Pezzi R, Fontana V, Fedeli F, Pistillo MP, Roncella S. Evaluation of soluble mesothelin-related peptide as a diagnostic marker of malignant pleural mesothelioma effusions: its contribution to cytology. Cancer Invest. 2013;31(1):48–55.

    Article  CAS  Google Scholar 

  14. Sackett DL, Haynes RB. Evidence base of clinical diagnosis the architecture of diagnostic research. BMJ. 2002;324:539–41.

    Article  PubMed  CAS  Google Scholar 

  15. Gennaro V, Ugolini D, Viarengo P, Benfatto L, Bianchelli M, Lazzaretto A, Montanaro F, Puntoni R. Incidence of pleural mesothelioma in Liguria Region, Italy (1996–2002). Eur J of Cancer. 2005;41:2709–14.

    Article  CAS  Google Scholar 

  16. Ferro P, Canessa PA, Battolla E, Dessanti P, Franceschini MC, Chiaffi L, Morabito A, Fontana V, Pezzi R, Fedeli F, Pistillo MP, Roncella S. Mesothelin is more useful in pleural effusion than in serum in the diagnosis of pleural mesothelioma. Anticancer Res. 2013;33:2707–14.

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors thank A. Camaiora, V. Balestracci and R. Tome for collecting the PE samples, the staff of the Division of Pneumology, and of the Division of Histopathology and Cytopathology of the ASL 5 “Spezzino” (Italy). In addition we thank Dr. M. P. Pistillo for critically reading of the manuscript. This work was supported by a Grant from Fondazione Carispe and by a Grant from Ricerca Sanitaria Regione Liguria 2009.

Conflict of interest

The authors attest that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Pier Aldo Canessa.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Canessa, P.A., Ferro, P., Manta, C. et al. Clinical value of mesothelin in pleural effusions versus histology by medical thoracoscopy: brief report. Med Oncol 30, 649 (2013). https://doi.org/10.1007/s12032-013-0649-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s12032-013-0649-x

Keywords

Navigation