Early detection of malignant pleural mesothelioma through measurement of soluble mesothelin-related protein and positron emission tomography

Our plain-English summary of Early detection of malignant pleural mesothelioma through measurement of soluble mesothelin-related protein and positron emission tomography, by E.L. O'Lone, E.K. Park, A. Sandrini, et al (The Medical Journal of Australia, 2009).

The study

• Authors: E.L. O'Lone, E.K. Park, A. Sandrini, G.B. Fogarty, D.H. Yates
• Journal: The Medical Journal of Australia
• Published: 2009;190(3):158-9
• Type of article: Case report
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A 51-year-old man with no known history of asbestos exposure presented with hydropneumothorax. Soluble mesothelin-related protein testing and combined positron emission tomography and computed tomography were used to diagnose malignant pleural mesothelioma. One year after radical surgery and radiotherapy, there was no clinical recurrence.

In plain English

This case report from Australia described one patient: a 51-year-old man born in South Africa who had never smoked and reported no occupational or non-occupational asbestos exposure. Imaging showed a right-sided hydropneumothorax (air and fluid around the lung). Fluid tests showed no cancer cells, and thoracoscopic biopsies were read as probably a reactive change. Because the cause remained unexplained, a blood test for soluble mesothelin-related protein (SMRP) was done. The level was 2.8nM, above the reference range of under 2.5nM. A PET/CT scan showed intense tracer uptake suggesting malignant pleural mesothelioma, which surgery confirmed. The patient had a radical right pleuropneumonectomy and radiotherapy. One year after surgery, PET/CT showed no residual tumour and SMRP was within the reference range. The patient was well 19 months after surgery. The authors concluded that mesothelioma may not always be related to asbestos exposure, and that SMRP testing and PET/CT may enable early detection and improve survival. They noted that further follow-up was needed and that such surgery is not proven in controlled studies.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 51-year-old man, born in South Africa, who had lived and worked in sales in Australia since 1995; a never-smoker
• Exposure: No known asbestos exposure, occupational or non-occupational. The patient had not lived near asbestos mines or done renovation or building work. He had worked selling perspex and acrylic products, not manufacturing them.
• Main results:
  • Biopsy specimens taken at presentation were reported as proliferating mesothelial cells, probably a reactive change, and the patient was discharged with a presumed reactive effusion
  • The patient's serum SMRP level was 2.8nM, above the reference range of under 2.5nM
  • On review, the original biopsy specimens still showed no evidence of malignancy
  • PET/CT showed intense tracer uptake suggesting malignant pleural mesothelioma in the right pleura
  • At thoracotomy, frozen sections confirmed malignant pleural mesothelioma. A radical right pleuropneumonectomy was performed, followed by adjuvant radiotherapy.
  • One year after surgery, repeat PET/CT showed no residual tumour or lymph node tracer uptake, and SMRP was within the reference range
  • The patient remained well 19 months after surgery
• The authors' conclusion: The authors concluded that malignant pleural mesothelioma may not always be related to asbestos exposure and should be considered even without it. They also concluded that SMRP testing and PET/CT scanning may enable early detection and improve survival, and that mesothelioma may not have been suspected in this patient without SMRP testing.
• Limitations the authors state:
  • The authors stated that further follow-up is needed to confirm the patient's outcome
  • The authors stated that radical surgery and radiotherapy are not proven in controlled studies, and that there are no level 1 evidence-based data that additional surgery prolongs survival

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Mesothelin, Asbestos Exposure.

Related studies

• Soluble mesothelin-related protein in an asbestos-exposed population: the dust diseases board cohort study — E.K. Park, A. Sandrini, et al. (2008)
• Factors affecting soluble mesothelin related protein levels in an asbestos-exposed population — E.K. Park, P.S. Thomas, et al. (2010)
• Soluble mesothelin-related protein--a blood test for mesothelioma — B.W. Robinson, J. Creaney, et al. (2005)
• Soluble mesothelin related peptides (SMRP) and osteopontin as protein biomarkers for malignant mesothelioma: analytical validation of ELISA based assays and characterization at mRNA and protein levels — A.J. Rai, R.M. Flores, et al. (2010)
• Serum mesothelin for early detection of asbestos-induced cancer malignant mesothelioma — J. Creaney, N.J. Olsen, et al. (2010)
• Clinical value of fluorodeoxyglucose-positron emission tomography/computed tomography in differentiation of malignant mesothelioma from asbestos-related benign pleural disease: an observational pilot study — H. Yildirim, M. Metintas, et al. (2009)

Browse more research in The Medical Journal of Australia, or return to medical research.