Abstract
Secretory leukocyte peptidase inhibitor (SLPI) is a biomarker present in the respiratory tract that protects against tissue destruction and aids in wound healing. We examined whether SLPI in pleural effusion can be used to distinguish benign asbestos pleural effusion (BAPE) from early-stage malignant pleural mesothelioma (MPM) and other diseases. We measured the levels of SLPI, hyaluronic acid (HA), soluble mesothelin-related peptides (SMRP), CCL2, galectin-3, and CYFRA21-1 in 51 patients with BAPE, 37 patients with early-stage MPM, 77 patients with pleural effusions due to non-small-cell lung cancer (LCa), and 74 patients with other pleural effusions. SLPI levels in the pleural fluid of patients with BAPE were significantly lower than those in patients with MPM, LCa, and other pleural effusions (p < 0.0001). The area under the curve (AUC) for SLPI’s ability to distinguish BAPE from MPM was 0.902, with a sensitivity of 82.4% and a specificity of 86.5%. This AUC was not only favourable but was better than the AUC for the ability of CYFRA21-1 to distinguish BAPE (0.853). The combination of SLPI and CYFRA21-1 achieved an AUC of 0.965 for the differentiation between BAPE and MPM. Pleural fluid SLPI as well as CYFRA21-1 and HA is useful as a biomarker to diagnose BAPE, which needs to be distinguished from early-stage MPM.
Highlights
Secretory leukocyte peptidase inhibitor (SLPI) is a biomarker present in the respiratory tract that protects against tissue destruction and aids in wound healing
When the receiver operating characteristic (ROC) curve was drawn to confirm the reliability of SLPI to differentiate between benign asbestos pleural effusion (BAPE) and malignant pleural mesothelioma (MPM) and the cut-off value was 82.9 ng/mL, we found that the sensitivity was 82.4%, the specificity was 86.5%, and the area under the curve (AUC) was 0.902, indicating that SLPI is an effective differential marker (Fig. 6)
In the ROC curve for CYFRA21-1, the cut-off was 37.3, the sensitivity was 85.3%, and the specificity was 70.3. These results suggest that SLPI is a more effective marker than hyaluronic acid (HA) and soluble mesothelin-related peptides (SMRP), which are differential markers for mesothelioma, for the differential diagnosis of BAPE
Summary
Secretory leukocyte peptidase inhibitor (SLPI) is a biomarker present in the respiratory tract that protects against tissue destruction and aids in wound healing. We measured the levels of SLPI, hyaluronic acid (HA), soluble mesothelin-related peptides (SMRP), CCL2, galectin-3, and CYFRA21-1 in 51 patients with BAPE, 37 patients with early-stage MPM, 77 patients with pleural effusions due to non-small-cell lung cancer (LCa), and 74 patients with other pleural effusions. Abbreviations AUC Area under the curve BAPE Benign asbestos pleural effusion BRCA1 Breast cancer susceptibility gene I CCL2 C–C motif chemokine ligand 2 CYFRA21-1 Cytokeratin 19 fragment 21-1 CT Computed tomography FISH Fluorescence in situ hybridization HA Hyaluronic acid HF Heart failure IF Infection LCa Lung cancer MCP1 Monocyte chemotactic factor 1 MPM Malignant pleural mesothelioma ROC Receiver operating characteristic SLPI Secretory leukocyte peptidase inhibitor SMRP Soluble mesothelin-related peptides. Because the diagnosis of early-stage lesions and surgical treatment can improve prognoses, when patients with a history of asbestos exposure present with pleural effusion, BAPE should be considered for a differential diagnosis from MPM. The detection of BRCA1-associated protein 1 deletion in cell nuclei as well as deletion of the p16 gene is reportedly important[4]
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