title: Pleural fluid mesothelin as an adjunct to the diagnosis of pleural malignant mesothelioma.
abstract: BACKGROUND
  The diagnosis of pleural malignant mesothelioma (MM) by effusion cytology may be difficult and is currently controversial. Effusion mesothelin levels are increased in patients with MM but the clinical role of this test is uncertain.
  
  
  OBJECTIVE
  To determine the clinical value of measuring mesothelin levels in pleural effusion supernatant to aid diagnosis of MM.
  
  
  METHODS
  Pleural effusion samples were collected prospectively from 1331 consecutive patients. Mesothelin levels were determined by commercial ELISA in effusions and their relationship to concurrent pathology reporting and final clinical diagnosis was determined.
  
  
  RESULTS
  2156 pleural effusion samples from 1331 individuals were analysed. The final clinical diagnosis was 183 MM, 436 non-MM malignancy, and 712 nonmalignant effusions. Effusion mesothelin had a sensitivity of 67% for MM at 95% specificity. Mesothelin was elevated in over 47% of MM cases in effusions obtained before definitive diagnosis of MM was established. In the setting of inconclusive effusion cytology, effusion mesothelin had a positive predictive value of 79% for MM and 94% for malignancy.
  
  
  CONCLUSIONS
  A mesothelin-positive pleural effusion, irrespective of the identification of malignant cells, indicates the likely presence of malignancy and adds weight to the clinical rationale for further investigation to establish a malignant diagnosis.
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, M503, 23 Stirling Highway, Crawley, Perth, WA 6009, Australia ; National Centre for Asbestos Related Diseases, University of Western Australia, Nedlands, WA 6009, Australia.
authors.forename: Jenette
authors.identifier: 0000-0002-9391-9395
authors.initials: J
authors.lastname: Creaney
authors.affiliation: PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, WA 6009, Australia.
authors.forename: Amanda
authors.initials: A
authors.lastname: Segal
authors.affiliation: Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia ; School of Population Health, University of Western Australia, Crawley, WA 6009, Australia.
authors.forename: Nola
authors.initials: N
authors.lastname: Olsen
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, M503, 23 Stirling Highway, Crawley, Perth, WA 6009, Australia ; National Centre for Asbestos Related Diseases, University of Western Australia, Nedlands, WA 6009, Australia.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Dick
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, M503, 23 Stirling Highway, Crawley, Perth, WA 6009, Australia ; National Centre for Asbestos Related Diseases, University of Western Australia, Nedlands, WA 6009, Australia ; Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia ; School of Population Health, University of Western Australia, Crawley, WA 6009, Australia.
authors.forename: A W Bill
authors.initials: AW
authors.lastname: Musk
authors.affiliation: Biostatistics Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Skates
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, M503, 23 Stirling Highway, Crawley, Perth, WA 6009, Australia ; National Centre for Asbestos Related Diseases, University of Western Australia, Nedlands, WA 6009, Australia ; Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia.
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Robinson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism*; D005260:Female; D058851:GPI-Linked Proteins / Q000378:metabolism*; D006801:Humans; D008297:Male; D000090204:Mesothelin; D008654:Mesothelioma / Q000175:diagnosis / Q000378:metabolism*; D008875:Middle Aged; D016066:Pleural Effusion, Malignant / Q000175:diagnosis / Q000378:metabolism*; D011446:Prospective Studies; D012372:ROC Curve; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D058851:GPI-Linked Proteins; D000090204:Mesothelin