Diagnostic efficacy of fibulin-3 and mesothelin volue in malignant pleural mesothelioma

Malignant pleural mesothelioma (MPM) is a tumor associated with environmental or occupational asbestos exposure with poor prognosis. Diagnosis of MPM and differentiation from other malignant diseases may be challenging. Novel methods for early and noninvasive diagnosis of MPM is needed. We aimed to determine the diagnostic value of fibulin-3 and mesothelin in the diagnosis of MPM and compare with effusions related to other causes. The study was conducted at Gaziantep University clinics between December 2013 and July 2015. The study population consisted of 142 patients with pleural effusions (23 MPM, 42 malignant pleural effusion (MPE) other than MPM, 41 parapneumonic effusion, 12 inflammatory exudates and 24 transudative effusion). Mesothelin and fibulin-3 levels were determined by ELISA. Pleural fluid fibulin-3 and mesothelin levels were higher in 118 patients with exudates than 24 patients with transudates (p<0.001, p=0.001, respectively), in 65 patients with malignant effusion than 77 patients with benign effusions (p<0.001 each). Among patients with malignant effusions, fibulin-3 levels were statistically higher in MPE than MPM (p=0.039) however there was no difference in mesothelin levels. We did not observe any correlation between mesothelin and fibulin-3 levels. When a cut-off level of >142.5 ng / ml was taken for fibulin-3, the sensitivity and specicificity for diagnosing malignant effusions were 96,9% and 67.5%, the area under the curve (AUC) 0.849, positive predictive value (PPV) 70,79%, negative predictive value (NPV) 96.23%. A cut-off level of >68.5 Nm for mesothelin was determined with 90.8% sensitivity and 75.3% specificity, the AUC level was 0,835, PPV 74.68%, NPV 90,48. Levels of mesothelin and fibulin-3 were not correlated with clinical stage or survival. Fibulin-3 and mesothelin may have diagnostic value for differentiating malignant effusions from benign effusions however further research is needed to determine their usefulness for prognosis.