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Determinazione della Mesotelina nel versamento pleurico: contributo alla citologia nella diagnosi del Mesotelioma pleurico maligno

Determination of mesothelin in pleural effusions: contribution to cytology for diagnosis of malignant pleural mesotelioma

  • Articolo Originale
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La Rivista Italiana della Medicina di Laboratorio - Italian Journal of Laboratory Medicine

Riassunto

Premesse

Il Mesotelioma pleurico (MPM) è un tumore molto aggressivo frequentemente associato alla comparsa di un versamento pleurico (MPM-VP). La diagnosi differenziale del MPM-VP viene effettuata mediante citologia, ma spesso risulta difficile. Lo scopo del presente lavoro è di valutare il contributo che la determinazione del livello di Mesotelina (MS) nel VP può offrire all’analisi citologica nella pratica clinica.

Metodi

La MS è stata determinata mediante il Kit Elisa Mesomark™ su un’aliquota di VP estratto mediante toracentesi. La citologia è stata valutata su strisci fissati e colorati con metodo Papanicolau.

Risultati

Nello studio sono stati arruolati 52 pazienti affetti da MPM e 223 con patologia diversa da MPM. La media geometrica del livello della MS era significativamente più elevata nei MPM-VP (19,0 nmol/L) che negli altri VP (1,2 nmol/L). Il livello di cut-off era stimato in 9,30 nmol/L con AUC=0,82, Sensibilità=75,0% e Specificità=87,9%. Valori di MS ≥cut-off erano trovati in 38/52 (73%) dei MPM-VP vs 27/223 (12%) degli altri VP (DOR=21,8; Pearson chi square test P-value <0,001).

In 5/23 (21,7%) dei MPM-VP citologia-positivi o sospetti positivi il livello di MS non confermava la diagnosi. Al contrario in 20/29 (69,0%) casi di MPM citologia-negativi, il valore di MS risultava positivo.

Conclusioni

La determinazione della MS nel VP può essere un valore aggiunto alla citologia per definire la diagnosi di MPM e può essere un test impiegabile nella pratica clinica nella diagnosi dei VP che insorgono in pazienti con sospetto MPM.

Summary

Background

Malignant pleural mesothelioma (MPM) is an aggressive tumour usually associated with the presence of pleural effusion (PE). Differential diagnosis of the PE can be difficult because cytological analysis shows low sensitivity and specificity. Measurement of solubile mesothelin peptides (MS) has been reported to provide a complementary tool to aid in the diagnosis of MPM.

The current study was undertaken to assess whether the levels of MS in PE may provide an additional diagnostic value to cytology and clinical practice.

Methods

MS was assessed by means of the MesoMark™ ELISA kit on a fraction of PE extracted by thoracentesis. Cytology was evaluated on fixed smears stained by Papanicolaou’s method.

Results

We evaluated MS in 52 MPM-PE and 223 PE of other origin. The geometric mean of MS levels in PE was significantly higher in MPM-PE (19.0 nmol/L) than in total other PE (3.5 nmol/L). The cut-off level was 9.30 nmol/L with an AUC of 82.0 (P-value <0.001), Sensitivity=75% and Specificity=87%. We found MS positive cases (-cut-off) in 38/52 (73%) of MPM-PE and MS in 27/223 (12%) of other PE (DOR 21.8; Pearson chisquare test P-value <0.001).

Moreover, in the 5/23 (21.7%) cytology positive/suspicious MPM-PE the levels of SMRP were <9.30 nmol/L (cut-off). In contrast, in the 20/29 (69.0%) MPM-PE in which cytology was found negative the MS levels resulted positive.

Conclusions

MS detection in MPM-PE may provide additional diagnostic value to cytology. The MS test may be incorporated into clinical practice of PE from patients suspicious for MPM.

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Correspondence to Silvio Roncella.

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Battolla, E., Canessa, P.A., Ferro, P. et al. Determinazione della Mesotelina nel versamento pleurico: contributo alla citologia nella diagnosi del Mesotelioma pleurico maligno. Riv Ital Med Lab 8, 94–100 (2012). https://doi.org/10.1007/s13631-012-0047-y

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  • DOI: https://doi.org/10.1007/s13631-012-0047-y

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