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Disease Markers
Volume 2014, Article ID 413946, 10 pages
http://dx.doi.org/10.1155/2014/413946
Research Article

Pleural Fluid Mesothelin as an Adjunct to the Diagnosis of Pleural Malignant Mesothelioma

1School of Medicine and Pharmacology, University of Western Australia, M503, 23 Stirling Highway, Crawley, Perth, WA 6009, Australia
2National Centre for Asbestos Related Diseases, University of Western Australia, Nedlands, WA 6009, Australia
3PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, WA 6009, Australia
4Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia
5School of Population Health, University of Western Australia, Crawley, WA 6009, Australia
6Biostatistics Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA

Received 22 August 2014; Accepted 30 October 2014; Published 23 November 2014

Academic Editor: Jeffrey C. Gildersleeve

Copyright © 2014 Jenette Creaney et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Rationale. The diagnosis of pleural malignant mesothelioma (MM) by effusion cytology may be difficult and is currently controversial. Effusion mesothelin levels are increased in patients with MM but the clinical role of this test is uncertain. Objectives. To determine the clinical value of measuring mesothelin levels in pleural effusion supernatant to aid diagnosis of MM. Methods and Measurements. Pleural effusion samples were collected prospectively from 1331 consecutive patients. Mesothelin levels were determined by commercial ELISA in effusions and their relationship to concurrent pathology reporting and final clinical diagnosis was determined. Results. 2156 pleural effusion samples from 1331 individuals were analysed. The final clinical diagnosis was 183 MM, 436 non-MM malignancy, and 712 nonmalignant effusions. Effusion mesothelin had a sensitivity of 67% for MM at 95% specificity. Mesothelin was elevated in over 47% of MM cases in effusions obtained before definitive diagnosis of MM was established. In the setting of inconclusive effusion cytology, effusion mesothelin had a positive predictive value of 79% for MM and 94% for malignancy. Conclusions. A mesothelin-positive pleural effusion, irrespective of the identification of malignant cells, indicates the likely presence of malignancy and adds weight to the clinical rationale for further investigation to establish a malignant diagnosis.