Data from: Pleural effusion biomarkers and computed tomography findings in diagnosing malignant pleural mesothelioma: a retrospective study in a single center

In this study, we aimed to examine the clinical value of the pleural
effusion (PE) biomarkers, soluble mesothelin-related peptide (SMRP),
cytokeratin 19 fragment (CYFRA 21-1) and carcinoembryonic antigen (CEA),
and the utility of combining chest computed tomography (CT) findings with
these biomarkers, in diagnosing malignant pleural mesothelioma (MPM). We
conducted a retrospective cohort study in a single center. Consecutive
patients with undiagnosed pleural effusions who underwent PE analysis
between September 2014 and August 2016 were reviewed. This study included
240 patients (32 with MPM and 208 non-MPM). SMRP and the CYFRA 21-1/CEA
ratio had a sensitivity and specificity for diagnosing MPM of 56.3% and
86.5%, and 87.5% and 74.0%, respectively. Using receiver operating
characteristics (ROC) curve analysis of the ability of these markers to
distinguish MPM from all other PE causes, the area under the ROC curve
(AUC) for SMRP and the CYFRA 21-1/CEA ratio was 0.804 and 0.874,
respectively. The sensitivity and specificity of SMRP combined with the
CYFRA 21-1/CEA ratio were 93.8% and 64.9%, respectively. The sensitivity
of the combination of SMRP, the CYFRA 21-1/CEA ratio, and the presence of
Leung's criteria (a chest CT finding that is suggestive of malignant
pleural disease) was 93.8%. In conclusion, the combined PE biomarkers had
a high sensitivity for diagnosing MPM, although the addition of chest CT
findings did not improve the sensitivity of SMRP combined with the CYFRA
21-1/CEA ratio. Combination of these biomarkers helped to rule out MPM
effectively among patients at high risk of suffering MPM and would be
valuable especially for old frail patients who have difficulty in
undergoing invasive procedures such as thoracoscopy.