title: Combination of mesothelin and CEA significantly improves the differentiation between malignant pleural mesothelioma, benign asbestos disease, and lung cancer.
abstract: BACKGROUND
  Soluble mesothelin-related peptides (SMRP) have been reported as potential markers for the diagnosis of malignant pleural mesothelioma (MPM). We wondered, whether a combination with a carcinoembryonic antigen (CEA) test might improve the relatively low diagnostic yield of the SMRP test.
  
  
  METHODS
  In a retrospective study, SMRP (mesothelin) and CEA serum concentrations were measured, using commercially available kits, in 93 previously untreated MPM patients, 75 patients with benign asbestos disease, and 139 patients suffering from lung cancer (LC).
  
  
  RESULTS
  The differentiation between MPM, LC, and benign asbestos disease could be improved by applying the ratio mesothelin/CEA. Whereas CEA expression was found to be low in MPM, most LC patients had elevated CEA serum levels. The area under curve (AUC) of the receiver operator characteristics curve for mesothelin alone was found to be only 0.708. For mesothelin/CEA the AUC of the receiver operator characteristics curve increased to 0.978. The sensitivity was 93% (69%) at 95% (100%) specificity for the differentiation between MPM and LC. Comparison of MPM and benign asbestos disease showed that the AUC was 0.887 and the sensitivity 56% (47%) at 95% (100%) specificity. In contrast, the AUC for the mesothelin test alone was only 0.715, and for the CEA test alone it was 0.16. An average increment in sensitivity of 38% (range, 16%-63%) could be achieved by the quotient mesothelin/CEA compared with the sensitivity of mesothelin alone.
  
  
  CONCLUSIONS
  The diagnostic yield of the mesothelin test can be considerably improved when combined with a CEA test with regard to the differential diagnosis between MPM and LC and between MPM and benign asbestos disease.
authors.affiliation: Translational Research Unit, Thoraxklinik am Universitätsklinikum Heidelberg, Heidelberg, Germany. thomas.muley@thoraxklinik-heidelberg.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Muley
authors.forename: Hendrik
authors.initials: H
authors.lastname: Dienemann
authors.forename: Felix J F
authors.initials: FJ
authors.lastname: Herth
authors.forename: Michael
authors.initials: M
authors.lastname: Thomas
authors.forename: Michael
authors.initials: M
authors.lastname: Meister
authors.forename: Joachim
authors.initials: J
authors.lastname: Schneider
mesh_terms: D001195:Asbestosis / Q000097:blood / Q000175:diagnosis*; D014408:Biomarkers, Tumor / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood*; D018287:Carcinoma, Large Cell / Q000097:blood / Q000175:diagnosis; D002294:Carcinoma, Squamous Cell / Q000097:blood / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D058851:GPI-Linked Proteins / Q000097:blood*; D006801:Humans; D008175:Lung Neoplasms / Q000097:blood / Q000175:diagnosis*; D008297:Male; D000090204:Mesothelin; D008654:Mesothelioma / Q000097:blood / Q000175:diagnosis*; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D009367:Neoplasm Staging; D010997:Pleural Neoplasms / Q000097:blood / Q000175:diagnosis*; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D055752:Small Cell Lung Carcinoma / Q000097:blood / Q000175:diagnosis*
chemical_list: D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen; D058851:GPI-Linked Proteins; D000090204:Mesothelin