Value of plasma and pleural effusion fibulin-3 levels in the diagnosis of malignant pleural mesothelioma effusions

Abstract

Background: Malignant pleural mesothelioma (MPM) is a highly aggressive tumor that arises from the surface cells of the pleura with a poor survival rate. Fibulin-3 is a protein biomarker found in blood and pleural fluid of patients with mesothelioma and can reliably predict the presence, or absence, of mesothelioma cancer cells. The possible role of fibulin-3 in diagnosis of MPM was studied. Patients and methods: Sixty patients were included in the study, 30 with pleural effusions due to MPM and another 30 with non mesothelioma malignant pleural effusion (MPE). Plasma and pleural effusion fibulin-3 levels were estimated for all patients using an enzyme-linked immunosorbent assay (ELIZA). Results: Plasma and pleural effusion fibulin-3 levels were significantly higher in patients with MPM (113 ± 3.7 ng/ml and 594.2 ± 65.7 ng/ml, respectively) compared to those with non mesothelioma MPE (44.4 ± 7.1 ng/ml and 187.3 ± 14.5 ng/ml, respectively) (P < 0.001). Plasma and effusion fibulin-3 levels discriminated significantly between patients with MPM and those with non mesothelioma MPE, with area under receiver operating characteristic (ROC) curves of 0.98 and 0.94, respectively, at cut-off values of 54.3 ng/ml for plasma fibulin-3 and 520 ng/ml for effusion fibulin-3, with sensitivity of 100% and 90%, specificity of 96.7% for both, positive predictive value (PPV) of 96.8% and 96.4% and negative predictive value (NPV) of 100% and 90.6%, respectively. Conclusion: Plasma and effusion fibulin-3 levels can differentiate mesothelioma effusions from other malignant effusions.

Keywords

• Fibulin-3
• Malignant pleural mesothelioma