SESSION TITLE: Pleural Effusions
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Tuesday, October 29, 2013 at 02:45 PM - 04:15 PM
PURPOSE: Malignant pleural mesothelioma (MPM) is a highly aggressive neoplasm strongly associated with asbestos exposure. Patients with MPM often develop pleural fluid as initial presentation. However, cytological diagnosis with pleural fluid is usually difficult and has limited utility. We aimed to evaluate the usufulness of molecular markers in pleural fluid for the diagnosis of MPM.
METHODS: The subjects included 233 patients those were referred to Okayama Rosai Hospital between December 2005 and October 2011 for detailed examination of pleural effusion. Pleural fluid was collected from 52 patients with MPM, 78 with lung cancer (LC), 58 with benign asbestos pleurisy (BAP), and 45 with infectious pleuritis (IP). Hyaluronic acid (HA) concentration was determined by the latex agglutination turbidimetric immunoassay. Soluble mesothelin related peptide (SMRP) was measured by the chemiluminescent enzyme immunoassay. Concentrations of carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (CYFRA) were extracted from medical records. Comparisons between groups were performed using the Kruskal-Wallis test and nonparametric Mann-Whitney U test. Areas under receiver operating characteristic (ROC) curves (AUCs) were calculated using standard techniques.
RESULTS: The median (range) HA concentrations in pleural fluid were 63850 (7920-2630000) ng/ml in MPM, 19600 (2880-163000) ng/ml in LC, 2875 (900-123000) ng/ml in BAP group, 28000 (2690-108000) ng/ml in IP. SMRP concentrations were 13.0 (0.90-261.9) ng/ml in MPM, 5.96 (0.05-36.40) ng/ml in LC, 7.20 (1.10-18.41) ng/ml in BAP, and 4.16 (0.76-14.1) ng/ml in IP. HA levels in MPM were significantly higher than those in the other groups. Both of HA and SMRP levels in MPM were significantly higher than those in the other groups. We analyzed the utility of HA and SMRP for the differential diagnosis of MPM using ROC analysis. The AUC value of HA and SMRP for the differential diagnosis of MPM and other groups was 0.778 and 0.772, respectively. The diagnostic yield was increased by combination of these markers.
CONCLUSIONS: Determination and combination of molecular markers in pleural fluid would be useful for differential diagnosis of MPM.
CLINICAL IMPLICATIONS: MPM is highly suspected in the cases with elevated value of HA and/or SMRP.
DISCLOSURE: The following authors have nothing to disclose: Nobukazu Fujimoto, Michiko Asano, Yasuko Fuchimoto, Katsuichiro Ono, Shinji Ozaki, Takumi Kishimoto
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