The importance of serum and pleural fluid level of vascular endothelial growth factor (VEGF) and VEGF fluid/serum ratio in the differential diagnosis of malignant mesothelioma-related pleural effusion

Abstract

Aim of the studyVascular endothelial growth factor (VEGF) is one of the parameters that has been studied in differential diagnosis of malignant fluids. This study is aimed at evaluate applicability of serum, fluid VEGF level and fluid to serum VEGF ratio in the diagnosis of malignant pleural mesothelioma (MPM).Material and methodsThe patients with pleural effusion over age of 18, between 2011 and 2015 were included in the study. They were divided into three groups: group 1 – mesothelioma patients; group 2 – other malignancies; and group 3 – benign aetiologies. Group 1 and 2 were termed as the malignant group. Fluid, serum VEGF levels, and the ratio of fluid/serum VEGF level were studied to evaluate the fluid/serum VEGF ratio in all groups.ResultsTwenty cases with mesothelioma, 44 cases with other malignancies, and 20 cases with benign aetiologies were included in this study. No statistically significant difference was found according to serum VEGF levels for all groups, (group 1: 437 ±324 pg/ml, group 2: 354 ±223 pg/ml, group 3: 373 ±217 pg/ml, p = 0.836), while fluid VEGF levels showed a statistically significant difference (group 1: 3359 ±700 pg/ml, group 2: 2175 ±435 pg/ml, group 3: 1092 ±435 pg/ml, p = 0.041). The ratio of fluid to serum VEGF levels showed a difference, at the significance limit, between the malignant (group 1 and group 2) and benign (group 3) groups (8.83 ±1.29 vs. 4.57 ±1.07, p = 0.059) but showed a statistically significant difference between the mesothelioma and benign groups (12.11 ±1.68 vs. 4.57 ±1.07, p = 0.044).ConclusionsThe VEGF fluid/serum ratio may be an applicable parameter in the differential diagnosis of malignant fluids, especially MPM.

Diagnostic Role of Angiopoietin-2 and Vascular Endothelial Growth Factor in Malignant Pleural Effusion

“…Besides, there was a variation of significance in PF VEGF level among the three etiologies of benign exudative effusion (Parapneumonic, Tuberculosis and Empyema), however in case of heart failure and hepatic hydrothorax it has a non-significant changes between them (Table 3) In concordance with results of former studies, malignant and para-pneumonic pleural effusions recorded a higher PF VEGF levels than that found in pleural effusion due to heart failure [24,30,31]. Düzkoprü et al [16] results of their study revealed PF VEGF mean value was 3359 ±700 pg/ml in mesothelioma patients, 2175 ±435 pg/ml in nonmesothelioma patients, and 1092 ±435 pg/ml in bengin exudate group, accordingly it was concluded that, in mesothelioma group VEGF mean value was the highest than that observed in the benign exudative group with a statistically significant difference. In contrary to our study, Thickett and colleagues [5] noted lower mean values of VEGF in malignant diseases than in empyema.…”

“…),and patients on medications (eg. : anticancer therapy or corticosteroids or antiinflammatory drugs) [16].…”

“…Fafliora et al [36] stated that PF VEGF levels among patients with malignant PE were increased by 1.93 ng/mL as compared to patients with benign PE Bradshaw et al [14] concluded that PF VEGF at 2000 pg/mL had an important role in diagnosing malignant pleural effusion especially mesothelioma type, associated with poor prognosis [37]. Moreover VEGF accompanied with angiogenesis participate in the pathophysiology and advancement of mesothelioma [38] .Besides, Düzkoprü et al [16]postulated a significant increase of PF VEGF in malignant pleural effusions with higher values in mesothelioma than other causes of malignant pleural effusion.…”

“…However, Shen et al [39] suggested a lower sensitivity and specificity (75% and 72%) respectively, in predicting malignant PE. Accordingly, it was suggested that VEGF should be accompanied with other pleural fluid biomarkers in the evaluation of MPE [16]. On the contradicted side, Fiorelli and colleagues [4] concluded that PF VEGF level couldn't differentiate lung cancer from other malignancies especially mesothelioma.…”

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“…This was statistically significant (p=0.01). A recent study also mentioned this relationship [27].Ökten et al reported that, 83% of the pleural effusion patients had MPM. This value was very similar to our results [28].…”