Key result
High pleural fluid-to-blood BNP ratio detects malignant mesothelioma effusions with ~92% sensitivity.
Why the study?
Given the shared embryonic mesodermal origin of mesothelial cells and cardiomyocytes, the authors investigated whether malignant mesothelioma cells secrete BNP and whether this has diagnostic utility.
Does the pleural fluid to blood BNP ratio accurately diagnose malignant mesothelioma?
Observational (n=99)
Does the pleural fluid to blood BNP ratio accurately diagnose malignant mesothelioma?
Malignant mesothelioma cells secrete BNP, and a high pleural fluid to blood BNP ratio can serve as a highly sensitive and specific diagnostic marker for malignant mesothelioma.
Answers are grounded in this paper and cite their sources.
May support BNP ratio in mesothelioma effusions but should not yet change practice; leaves open need for prospective validation.
BACKGROUND AND OBJECTIVE: Mesothelial cells and cardiomyocytes have shared embryonic mesodermal origin. Cardiomyocytes release BNP under stretch. We searched whether malignant mesothelioma cells also secrete BNP and if so, this has a meaningful impact. METHODS: Part I: Prospectively, patients with pleural lesions on CT having malignant mesothelioma effusions (MME, n = 13) were compared to patients with malignant effusions with pleural lesions (MEa, n = 14). Age-matched patients with ME without pleural lesions (MEb, n = 16) and non-malignant effusions (NME, n = 25) were analysed. Part II: Retrospectively, samples from patients with mesothelioma (n = 14), lung cancer (n = 8) or heart failure (n = 9) were used. BNP was measured in pleural fluid and blood/plasma. Part III: BNP was assessed in the culture supernatants of benign (MeT-5A) and malignant mesothelioma cell lines (M14K-epithelioid, MSTO-biphasic and ZL34-sarcomatoid) (n = 10 per cell line in three different biological replicates). RESULTS: In vitro, BNP concentration was significantly higher in the supernatant of all malignant cell lines than benign ones (P < 0.01), denoting BNP's production from the former. The pleural fluid to blood BNP ratio in MME was extremely high in Part I and Part II subjects (28.3 ± 12.1 and 25.9 ± 8.6, respectively) versus 1.1 ± 0.3 and 0.4 ± 0.1 in Part I ME and NME, respectively (P < 0.0001), and 0.8 ± 0.1 and 0.4 ± 0.1 in Part II ME and NME, respectively (P < 0.0001). BNP ratio ≥2.11 in Part I had 92% sensitivity and 94.5% specificity for MME (P < 0.0001). CONCLUSION: BNP is secreted from malignant mesothelial cells. In clinical practice, the pleural fluid to blood BNP ratio can help in the diagnosis of malignant mesothelioma.
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Tsolaki et al. (2020) conducted an observational in Malignant mesothelioma (n=99). Pleural fluid to blood BNP ratio vs. Other malignant and non-malignant effusions was evaluated on Pleural fluid to blood BNP ratio (p=<0.0001). A pleural fluid to blood BNP ratio ≥2.11 demonstrated 92% sensitivity and 94.5% specificity for diagnosing malignant mesothelioma effusions (P<0.0001).
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