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

BackgroundMalignant 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 methodsSixty 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).ResultsPlasma 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.ConclusionPlasma and effusion fibulin-3 levels can differentiate mesothelioma effusions from other malignant effusions.