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Disorders of the Pleura |

Clinical Relevance of Positive Pleural Effusion Soluble Mesothelin-Related Peptide in Nonmalignant Pleuritis

Pier Aldo Canessa, MD; Paola Ferro, PhD; Maria Cristiana Franceschini, PhD; Vanna Balestracci, MS; Massimiliano Sivori, MD; Donatella Fini, MD; Enrico Battolla, MD; Vincenzo Fontana, PhD; Franco Fedeli, MD; Maria Pia Pistillo, PhD; Silvio Roncella, PhD
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ASL5 Spezzino, La Spezia, Italy


Chest. 2013;144(4_MeetingAbstracts):517A. doi:10.1378/chest.1702541
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Abstract

SESSION TITLE: Pleural Effusions

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Tuesday, October 29, 2013 at 02:45 PM - 04:15 PM

PURPOSE: Soluble mesothelin-related peptide (SMRP) is regarded as a new promising biomarker for the diagnosis of mesothelioma (MPM) using pleural effusion (PE). In this study, we assessed the relative risk (RR) of cancer in patients diagnosed with non-malignant pleuritis using PE-SMRP levels.

METHODS: During March/2008-December/2012, in the Pneumology Department of the Sarzana Hospital (Italy), 86 out of 226 patients with PE, who underwent thoracoscopy, were diagnosed with a benign pleural disease through histo-pathological biopsies and followed up for at least 18 months in order to detect cancer occurrence. PE-SMRP levels were measured by the “MesoMark” ELISA assay kit (Cis-Bio International Gif/Yvette; France). On the basis of the ROC analysis, a level of 20 nM was used as an optimal threshold for classifying patients. Logistic regression was applied to estimate RR and corresponding 95% confidence limits.

RESULTS: After a 18-month follow-up, 9/86 (10.5%) patients with negative thoracoscopy developed a pleural malignancy (7 mesotheliomas and 2 lymphomas), 5/9 (55.5%) (4 MPM and 1 lymphoma) had shown a PE-SMRP positive (> 20 nM) result at the time of the first thoracoscopy. In contrast, among 77/86 (89.5%) patients who did not develop malignancies, only 2/77 (2.6%) resulted PE-SMRP positive (both inflammatory pleuritis). In comparison with PE-SMRP negative patients, positive patients showed a RR = 46.9 (95% CL = 6.7-320.9; P-value < 0.001) for cancer and RR = 33.8 (95% CL = 5.1-223.6; P-value < 0.001) for MPM.

CONCLUSIONS: Our findings show that SMRP test may have a prognostic value.

CLINICAL IMPLICATIONS: We propose a possible application of SMRP detection in PE to point out a false-negative thoracoscopy in non-specific pleuritis.

DISCLOSURE: The following authors have nothing to disclose: Pier Aldo Canessa, Paola Ferro, Maria Cristiana Franceschini, Vanna Balestracci, Massimiliano Sivori, Donatella Fini, Enrico Battolla, Vincenzo Fontana, Franco Fedeli, Maria Pia Pistillo, Silvio Roncella

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