Abstract
Differential diagnosis of pleural effusion is an important issue, since the treatment modalities and prognosis strictly depend on early and correct diagnosis of the underlying etiology. We assessed the efficacy of vascular endothelial growth factor (VEGF) in the differential diagnosis of patients with malignant and non-malignant pleural diseases. And also is assessed of the VEGF as a marker for success of chemical pleurodesis in malignant pleural effusion. Pleural effusions of 40 patients with a mean age of 55 (range, 26 to 78 years) were examined. A total of 20 patients had malignant pleural effusion; malignant mesothelioma (n=7), lung cancer (n=5) and metastatic malignancies (n=8). Twenty patients had benign pleural effusion; fibrinous pleuritis (n=6), tuberculosis (n=3) empyema (n=5), congestive heart failure (n=3), and acute pancreatitis (n=3). Definitive diagnosis was obtained in all cases with blind or open pleural biopsy, and cytological examination. VEGF levels were determined by enzyme-linked immunosorbent assay. The VEGF level of pleural effusion was comparably higher in the malignant group. The mean level of VEGF in patients with malignant pleural effusions (21.7 ± 1.8 ng/ml) was significantly (P <0.001) higher than that of (13.2 ± 1.5 ng/ml) non-malignant effusions. No significant difference was found regarding the VEGF levels and histological types in malignant pleural effusions. Negative correlation was observed between success rate of pleurodesis and VEGF level of pleural effusion (p= 0.015). The measurement of VEGF levels in pleural effusion may be useful to differentiate malignant from nonmalignant pleural effusions. VEGF level may also be an important prognostic marker for effective treatment of the patients who had malignant pleural effusions with pleurodesis. It is important issue in here whether VEGF could be useful in prognostication of outcome of chemical pleurodesis or not.
Highlights
Pleural effusion is an important problem in malignant or non-malignant pleural disease, causing severe symptoms such as dyspnea and chest pain
Twenty patients had malignant pleural effusion associated with malignant mesothelioma (20.7 ± 3.8 ng/ml), lung cancer (24.2 ± 2.8 ng/ml), metastasis from genitourinary system carcinomas (21.3 ± 6.9 ng/ml) metastasis from breast carcinoma (19.7 ± 4.3 ng/ml), adenocarcinoma metastasis from gastrointestinal system (23.8 ng/ml), and NonHodgkin’s Lymphoma (21.1 ng/ml)
Blind pleural biopsy has been reported to be inadequate in up to 40% of the patients [5,6]. This situation puts forward the need for a different method directed to pleural fluid
Summary
Pleural effusion is an important problem in malignant or non-malignant pleural disease, causing severe symptoms such as dyspnea and chest pain. Inflammatory PE can be treated with success, contrary to malignant PE, in which the main goal is to decrease symptoms and increase the quality of life as much as possible. This “mandatory” differential diagnosis is still difficult, time-consuming and expensive. VEGF, produced by malignant pleural tissue, is thought to both enhance tumor angiogenesis leading to local growth, and increase vascular permeability leading to PE [2,3]
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