SC Pneumologia, Ospedale San Bartolomeo, via Cisa Sud, 19038, Sarzana, SP, Italy.
Med Oncol. 2013;30(3):649. doi: 10.1007/s12032-013-0649-x. Epub 2013 Jul 20.
The aim of this study based on the third phase of the architecture of diagnostic research was to assess the sensitivity and specificity of soluble mesothelin-related peptide (SMRP) in pleural exudative effusions (PE) compared to the histology obtained by medical thoracoscopy as the diagnostic gold standard examination. We assessed 104 consecutive thoracoscopies. SMRP concentrations were obtained using an ELISA test. We had 34 mesotheliomas (25 epithelioid and 9 sarcomatoid), 35 pleural metastases, and 35 benign diseases. PE-SMRP were significantly higher in patients with epitheliomorphic mesothelioma (mean ± SD 46.55 ± 44.29 nM) than in patients with sarcomatoid mesothelioma (16.11 ± 25.02 nM; p = 0.061), pleural metastasis (7.52 ± 10.77 nM; p < 0.0001), or benign diseases (5.82 ± 8.86 nM; p < 0.0001). Using ROC curve analysis, PE-SMRP offered an AUC of 0.767 in its ability to differentiate between patients with mesothelioma and all other diagnoses. The diagnostic sensitivity and specificity of PE-SMRP for distinguishing mesothelioma from all other causes of pleural effusion, at a cut-off value of 19.6 nM, were 58.8 and 97.1 %, respectively. PE-SMRP higher than the assumed cut-off of 19.6 nM were observed in 18/25 (72.0%) epitheliomorphic mesotheliomas, 2/9 (22.2%) sarcomatoid mesotheliomas, 5/35 (14.3%) pleural metastases, and 1/35 (2.9%) benign diseases. We conclude that PE-SMRP adds some clinical information in the work-up of patients with a PE of unknown origin: (1) thoracoscopy should always be done in patients with a positive mesothelin; (2) a negative mesothelin does not exclude a malignant disease.
本研究基于诊断研究的第三阶段架构，旨在评估可溶性间皮素相关肽（SMRP）在胸腔渗出液（PE）中的敏感性和特异性，与作为诊断金标准检查的医学胸腔镜获得的组织学相比。我们评估了 104 例连续胸腔镜检查。使用 ELISA 试验获得 SMRP 浓度。我们有 34 例间皮瘤（25 例上皮样和 9 例肉瘤样）、35 例胸膜转移和 35 例良性疾病。上皮样间皮瘤患者的 PE-SMRP 明显高于肉瘤样间皮瘤患者（平均值 ± 标准差 46.55 ± 44.29 nM）（16.11 ± 25.02 nM；p = 0.061）、胸膜转移（7.52 ± 10.77 nM；p < 0.0001）或良性疾病（5.82 ± 8.86 nM；p < 0.0001）。使用 ROC 曲线分析，PE-SMRP 在区分间皮瘤患者和所有其他诊断方面的 AUC 为 0.767。PE-SMRP 用于区分间皮瘤与所有其他胸腔积液病因的诊断敏感性和特异性，在截断值为 19.6 nM 时，分别为 58.8%和 97.1%。在假设的截断值 19.6 nM 以上观察到 18/25（72.0%）上皮样间皮瘤、2/9（22.2%）肉瘤样间皮瘤、5/35（14.3%）胸膜转移和 1/35（2.9%）良性疾病。我们得出结论，PE-SMRP 在未知来源的 PE 患者的检查中提供了一些临床信息：（1）在间皮素阳性的患者中应始终进行胸腔镜检查；（2）间皮素阴性不能排除恶性疾病。
