Pleural effusion biomarkers and computed tomography findings in diagnosing malignant pleural mesothelioma: A retrospective study in a single center

Abstract

In this study, we aimed to examine the clinical value of the pleural effusion (PE) biomarkers, soluble mesothelin-related peptide (SMRP), cytokeratin 19 fragment (CYFRA 21–1) and carcinoembryonic antigen (CEA), and the utility of combining chest computed tomography (CT) findings with these biomarkers, in diagnosing malignant pleural mesothelioma (MPM). We conducted a retrospective cohort study in a single center. Consecutive patients with undiagnosed pleural effusions who underwent PE analysis between September 2014 and August 2016 were reviewed. This study included 240 patients (32 with MPM and 208 non-MPM). SMRP and the CYFRA 21-1/CEA ratio had a sensitivity and specificity for diagnosing MPM of 56.3% and 86.5%, and 87.5% and 74.0%, respectively. Using receiver operating characteristics (ROC) curve analysis of the ability of these markers to distinguish MPM from all other PE causes, the area under the ROC curve (AUC) for SMRP and the CYFRA 21-1/CEA ratio was 0.804 and 0.874, respectively. The sensitivity and specificity of SMRP combined with the CYFRA 21-1/CEA ratio were 93.8% and 64.9%, respectively. The sensitivity of the combination of SMRP, the CYFRA 21-1/CEA ratio, and the presence of Leung’s criteria (a chest CT finding that is suggestive of malignant pleural disease) was 93.8%. In conclusion, the combined PE biomarkers had a high sensitivity for diagnosing MPM, although the addition of chest CT findings did not improve the sensitivity of SMRP combined with the CYFRA 21-1/CEA ratio. Combination of these biomarkers helped to rule out MPM effectively among patients at high risk of suffering MPM and would be valuable especially for old frail patients who have difficulty in undergoing invasive procedures such as thoracoscopy.

Diagnostic value of soluble mesothelin-related peptides in pleural effusion for malignant pleural mesothelioma

“…Ultimately, 13 studies met our eligibility criteria were included in this meta-analysis, involving a total of 3359 patients. [16–28] One study had 2 best diagnostic performances, which were considered 2 independent studies. [17]…”

“…Most studies [17–26] used histopathologic immunochemistry method as diagnostic criteria for MPM, only 3 studies [16,27,28] used PE cytology with biopsy histology as diagnostic criteria.…”

“…In term of the type of study, 8 studies [16,19–23,25,28] were cohort study that enrolled a consecutive or random sample of patients, 4 studies [17,24,26,27] were case–control designed, and 1 study [18] was an unclear type that enrolled a consecutive sample of eligible patients with suspected disease and a portion of participants with known disease. In addition to 2 studies [24,28] measuring SMRPs using the chemiluminescent enzyme immunoassay method, the rest of the studies used enzyme linked immunosorbent assay method. Finally, the cutoff values applied in 4 articles [16,21,25,28] were previously established.…”

PleThora: Pleural effusion and thoracic cavity segmentations in diseased lungs for benchmarking chest CT processing pipelines

“…58 Our pleural effusion segmentations are likely to be useful for investigating two questions surrounding a CT or PET/CT finding of pleural effusion: (a) the prognostic significance of pleural effusion in various cancer types, 59 and (b) the capacity of CT to discriminate between benign and malignant effusions. [60][61][62][63] Regarding the first question, Ryu et al 59 showed that in small cell lung cancer with stage I-III disease, the presence of even minimal pleural effusion confers an increased risk of death. Investigating the prognostic relationship of pleural effusion presence in other cancer types would presumably be facilitated by deep learning pleural effusion segmentation algorithms, such as might be trained with datasets like ours.…”

“…Our pleural effusion segmentations are likely to be useful for investigating two questions surrounding a CT or PET/CT finding of pleural effusion: (a) the prognostic significance of pleural effusion in various cancer types, 59 and (b) the capacity of CT to discriminate between benign and malignant effusions 60–63 . Regarding the first question, Ryu et al 59 showed that in small cell lung cancer with stage I–III disease, the presence of even minimal pleural effusion confers an increased risk of death.…”