Evaluation of soluble mesothelin-related peptide as a diagnostic marker of malignant pleural mesothelioma effusions: its contribution to cytology

Our plain-English summary of Evaluation of soluble mesothelin-related peptide as a diagnostic marker of malignant pleural mesothelioma effusions: its contribution to cytology, by P.A. Canessa, M.C. Franceschini, P. Ferro, et al (Cancer Investigation, 2013).

The study

• Authors: P.A. Canessa, M.C. Franceschini, P. Ferro, E. Battolla, P. Dessanti, C. Manta, M. Sivori, R. Pezzi, V. Fontana, F. Fedeli, M.P. Pistillo, S. Roncella
• Journal: Cancer Investigation
• Published: 2013;31(1):43-50
• Cited by: 16 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Soluble mesothelin-related peptide (SMRP) is regarded as an FDA approved biomarker for the diagnosis and monitoring of pleural malignant mesothelioma (MPM). We detected the SMRP levels in pleural effusions (PE) by means of an ELISA and analyzed their diagnostic relevance to differentiate MPM from benign pathology and from non-MPM pleural metastasis. Comparison with cytology in MPM-PE was also performed. We found that SMRP detection in MPM-PE can help the diagnosis of MPM and provide additional diagnostic value to cytology. We concluded that SMRP test may be incorporated into clinical practice of PE from patients suspicious for MPM.

In plain English

This study from La Spezia, Italy, an area the authors described as high-risk for mesothelioma because of widespread asbestos use, tested whether measuring soluble mesothelin-related peptide (SMRP) in fluid around the lungs helps diagnose malignant pleural mesothelioma. Fluid from 275 consecutive patients with an effusion of unknown origin (2008 to 2011) was tested: 52 had mesothelioma, 94 other cancers and 129 benign conditions. Median SMRP was 28.2 nmol/L in mesothelioma fluid, versus 3.2 nmol/L (benign) and 3.8 nmol/L (other cancers). At a cut-off of 9.30 nmol/L, SMRP was raised in 38/52 mesothelioma, 9/129 benign and 18/94 other-cancer effusions, and in 28/35 epithelioid versus 4/9 sarcomatoid mesotheliomas. Cytology was positive in 15/52 mesothelioma cases. SMRP was raised in 20/29 cytology-negative cases and 7/8 cytology-suspicious cases. One of the nine benign patients with raised SMRP was later found to have epithelioid pleural mesothelioma. The authors stated SMRP was not specific for mesothelioma and cannot replace cytology. They concluded the test can be applied when investigating effusions of unknown origin. Individual asbestos exposure was not reported.

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: Diagnostic accuracy study of a pleural-fluid biomarker (SMRP measured by ELISA) in consecutive patients, with comparison against cytology
• Who was studied: 275 consecutive patients (61.8% male, mean age 73.0, range 29 to 93) with a pleural effusion of unknown origin who underwent thoracentesis at the Division of Pneumology, Sarzana, La Spezia, Italy, February 2008 to July 2011. Of these, 52 had malignant pleural mesothelioma (35 epithelioid, 9 sarcomatoid, 4 biphasic, 2 desmoplastic, 2 papillary), 94 had effusions from other (non-mesothelioma) cancers, and 129 had benign diseases. The benign group included 7 exudates attributed to asbestosis.
• Exposure: Asbestos exposure of individual patients was not measured or reported. The study measured SMRP levels in pleural fluid. The authors described the Province of La Spezia as high-risk for MPM because of widespread asbestos use in shipbuilding, shipyards, oil refineries and petrochemical plants.
• Main results:
  • Median pleural-fluid SMRP was significantly higher in mesothelioma effusions (28.2 nmol/L, range 0.3 to 200) than in benign effusions (3.2 nmol/L, range 0.1 to 66.5) or effusions from other cancers (3.8 nmol/L, range 0.1 to 61.4)
  • Area under the ROC curve for mesothelioma effusions was 84.0% (95% CI 76.7 to 92.4) versus benign effusions and 80.0% (95% CI 71.4 to 87.7) versus other-cancer effusions, both p less than .001
  • At the cut-off of 9.30 nmol/L, sensitivity was 75.0%. Specificity was 93.0% versus benign effusions, 80.9% versus other-cancer effusions, and 87.9% versus all other effusions.
  • SMRP was above the cut-off in 38/52 (73.1%) mesothelioma effusions, 9/129 (6.9%) benign effusions and 18/94 (19.1%) other-cancer effusions
  • SMRP was raised in 28/35 (80.0%) epithelioid and 4/9 (44.4%) sarcomatoid mesothelioma effusions
  • Cytology was positive in 15/52 (28.8%) mesothelioma effusions
  • Among mesothelioma effusions, SMRP was raised in 20/29 (printed as 69.6%) cytology-negative cases and 7/8 (87.5%) cytology-suspicious cases
  • Of the 9 benign-effusion patients with raised SMRP, follow-up showed 1 had an epithelioid pleural mesothelioma and 2 developed a tumor
• The authors' conclusion: The authors concluded that the SMRP test can be applied in the work-up of patients with a pleural effusion of unknown origin.
• Limitations the authors state:
  • The authors stated that SMRP was not specific for mesothelioma, since raised levels were also found in benign and other-cancer effusions
  • SMRP was below the cut-off in 26.6% of cytology-positive mesothelioma effusions. The authors stated that SMRP is not an alternative to cytology but may add value.
  • The authors proposed that a raised SMRP should not be regarded as a diagnostic tool in itself, but as raising strong suspicion of mesothelioma (or metastatic) effusion

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelin, Pleural Mesothelioma, Cytology, Soluble Mesothelin-Related Peptides (SMRP), Biomarker, Malignant Mesothelioma, Pleural Effusion, Pathology.

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• Biomarkers in malignant mesothelioma: diagnostic and prognostic role of soluble mesothelin-related peptide — N. Dipalma, V. Luisi, et al. (2011)
• Evaluation of soluble mesothelin-related peptides and MSLN genetic variability in asbestos-related diseases — K. Goricar, V. Kovac, et al. (2020)
• Diagnostic value of soluble mesothelin-related peptides in pleural effusion for malignant pleural mesothelioma: An updated meta-analysis — R. Gao, F. Wang, et al. (2019)
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