Role of vascular endothelial growth factor (VEGF) in diagnosis of pleural effusion of different origins

BackgroundThe undiagnosed pleural effusions are an important clinical problem so scientists spent much effort and time in searching for a new parameter to help in the diagnosis of pleural effusions. Vascular endothelial growth factor (VEGF) helps in differentiation between malignant and inflammatory pleural effusions and might play an important role in tumor progression and the formation of malignant effusions.Aim of the workTo determine the level of pleural fluid VEGF in order to evaluate its value as a marker for differentiation between different types of pleural effusions.Subjects and methodsThe present study was conducted on 73 patients with pleural effusion, admitted to Kasr Elaini Hospital (Chest Department) during the period from August 2011 to October 2012, after having their written consent. All patients were subjected basically to full history taking, thorough clinical examination, routine laboratory investigations, plain chest radiography thoracentesis. Medical thoracoscopy was carried out for cases with undiagnosed exudative pleural effusion (n = 46).ResultsPleural fluid VEGF, and pleural fluid VEGF/serum VEGF ratio both are highest in malignant pleural effusion with statistically high significance (p < 0.001), followed by infectious effusion then tuberculous one. Using ROC curve analysis, the cut-off used for VEGF in pleural fluid in discriminating malignant from other groups is 1800 pg/ml with sensitivity of 95% and specificity of 96%.ConclusionVEGF is highest in malignant pleural effusion. The differential diagnosis of effusions might be further improved by including vascular endothelial growth factor concentrations into the diagnostic armentarium available to the clinician.