Assessment of the value of mesothelin in differentiating between different pleural malignancies by different interventional modalities

Abstract

Context
Malignant mesothelioma is an insidious neoplasm, with malignant pleural mesothelioma as the most common type, which is characterized by poor prognosis in most patients owing to late presentation. The use of noninvasive markers for early diagnosis of malignant pleural mesothelioma is of great importance in decreasing the incidence of associated morbidity and mortality.


Aims
To evaluate the value of soluble mesothelin level in serum and pleural fluid as a diagnostic marker in patients with pleural malignancies and in differentiation of different causes of pleural effusion.


Patients and methods
We included 48 patients who were classified into three groups: group A (mesothelioma), group B (metastatic malignancy), and group C (transudative effusion). History taking, clinical examination, and laboratory assessment were performed in all groups, in addition to measuring mesothelin level in serum and pleural fluid. Histopathological examination of pleural biopsies was performed in groups A and B.


Results
Mesothelin levels in serum and pleural fluid demonstrated a statistically significant increase in group A as compared with the cases in groups B and C (P<0.001). Moreover, mesothelin levels in serum and pleural fluid demonstrated a statistically significant increase in the samples taken from the cases in group B as compared with the cases in group C (P<0.001).


Conclusion
Soluble mesothelin-related peptides (SMRP) could be used as a valuable marker in diagnosis of different causes of pleural effusion. The diagnostic accuracy of pleural fluid SMRP was higher as compared with the serum SMRP.