title: Vascular endothelial growth factor in pleural fluid for differential diagnosis of benign and malignant origin and its clinical applications.
abstract: Our goal was to determine the role of vascular endothelial growth factor (VEGF) in diagnosing of pleural effusion (PE) in order to select patients deserving of more aggressive procedures. Seventy-nine consecutive patients with undiagnosed unilateral PE were enrolled. Pleural VEGF levels, measured using enzyme-linked immunosorbent assay (ELISA), were correlated to etiology of PEs and other markers (protein, lactic dehydrogenase, amylase, glucose). The median level of VEGF in exudates (n=65) was significantly higher than that in transudates (P=0.0001) and among exudates, it was significantly higher in malignant (n=49) than that in benign exudates (P=0.005). No significant differences were observed between malignant effusions due to lung cancer (n=11) and other malignant effusions [mesothelioma (n=13) and/or extra-thoracic cancer]. Among all variables evaluated, logistic regression found that only VEGF was significantly correlated with the presence of malignant disease (P=0.002). Analysis of the receiver operating characterists (ROC) curves showed that the areas under the curve of VEGF were significantly larger than that of amylase (P=0.02), glucose (P=0.01), lactic dehydrogenase (P=0.001) and protein (P=0.01). VEGF increased the diagnostic rate of cytological examination by 24%. VEGF may represent a helpful adjunct to conventional diagnostic tools in ruling out malignancy as a probable diagnosis, thus guiding the selection of patients who might benefit from further invasive procedures.
authors.affiliation: Thoracic Surgery Unit, Second University of Naples, Naples, Italy.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Fiorelli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Vicidomini
authors.forename: Marina
authors.initials: M
authors.lastname: Di Domenico
authors.forename: Filomena
authors.initials: F
authors.lastname: Napolitano
authors.forename: Gaetana
authors.initials: G
authors.lastname: Messina
authors.forename: Floriana
authors.initials: F
authors.lastname: Morgillo
authors.forename: Fortunato
authors.initials: F
authors.lastname: Ciardiello
authors.forename: Mario
authors.initials: M
authors.lastname: Santini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000032:analysis; D015415:Biomarkers / Q000032:analysis; D003937:Diagnosis, Differential; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005947:Glucose / Q000032:analysis; D006801:Humans; D007558:Italy; D007770:L-Lactate Dehydrogenase / Q000032:analysis; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D019152:Paracentesis; D010996:Pleural Effusion / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D016066:Pleural Effusion, Malignant / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D042461:Vascular Endothelial Growth Factor A / Q000032:analysis*; D055815:Young Adult
chemical_list: D015415:Biomarkers; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D007770:L-Lactate Dehydrogenase; D000681:Amylases; D005947:Glucose