Differential diagnosis of malignant mesothelioma to pleural effusionof fluid/serum vascular endothelial growth factor (VEGF) importance of rate

Introduction: VEGF is one of the parameters that has been studied in differential diagnosis of malign fluids. This study is aimed to evaluate applicability of serum, fluid VEGF level and fluid to serum VEGF ratio in the diagnosis of mesothelioma. Materials and Methods: The patients with pleural effusion over age of 18, between period of 2011 and 2015 were included in the study. They were seperated into three group: 1 mesothelioma patients, group 2 other malignancies and group 3 benign etiologies. Group 1 and 2 were accepted as malign group. For evaluate fluid/serum VEGF ratio In all groups, fluid, serum VEGF levels and ratio of fluid/serum VEGF level were studied. Results: 20 cases with mesothelioma, 44 cases with other malignancies and 20 cases with benign etiologies were included in this study. No statistically significant difference were found between serum VEGF levels of 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 statistically significant difference. (group1: 3359±700 pg/ml, group 2: 2175±435 pg/ml, group 3: 1092±435 pg/ml, p:0.041). Ratio of fluid to serum VEGF levels showed no statistical difference between malign ( group 1 and group 2) and benign (group 3) groups. (malign group: 8.83±1.29, benign group: 4.57±1.07, p:0.059), but showed statistically significant difference between mesothelioma and benign groups. (Group 1: 12.11±1.68, Grup 3: 4.57±1.07, p:0.044). The cut off value of ratio of fluid to serum VEGF level was found 0,85 (sensitivity 76%; specificity 50%, roc analysis). According to this cut of value, when patiens were categorized as over 0.85 and lower 0.85, statistically significant difference between malign and benign groups were found. ( for malign group %75,9, benign group %50, p:0.032). Between mesothelioma and benign groups, the difference were within the statistical range( group1 : %77,8, group3 %50, p:0.076), in contrast the difference between mesothelioma and other malignancies showed no significance. (group1 %77,8, group2 % 75, p:0.822) Conclusion: VEGF can be an applicable parameter in the differential diagnosis of malign fluids. Further studies need to be done to support the applicability of fluid/serum VEGF ratio as a promising parameter for differantial diagnosis of the malign fluids. However these parameters should be evaluate with others parameters that using for differantial diagnosis malign fluids.