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Meta-Analysis
. 2014 Feb 24;4(2):e004145.
doi: 10.1136/bmjopen-2013-004145.

Diagnostic values of soluble mesothelin-related peptides for malignant pleural mesothelioma: updated meta-analysis

Ai Cui  1 , Xiao-Guang Jin, Kan Zhai, Zhao-Hui Tong, Huan-Zhong Shi
Affiliations
Meta-Analysis

Diagnostic values of soluble mesothelin-related peptides for malignant pleural mesothelioma: updated meta-analysis

Ai Cui et al. BMJ Open. .

Abstract

Objective: Although the values of soluble mesothelin-related peptides (SMRPs), including mesothelin and megakaryocyte potentiating factor, in serum and/or pleural fluid for diagnosing malignant pleural mesothelioma (MPM) have been extensively studied, the exact diagnostic accuracy of these SMRPs remains controversial. The purpose of the present meta-analysis is to update the overall diagnostic accuracy of SMRPs in serum and, furthermore, to establish diagnostic accuracy of SMRPs in pleural fluid for MPM.

Design: Systematic review and meta-analysis.

Methods: A total of 30 articles of diagnostic studies were included in the current meta-analysis. Sensitivity, specificity and other measures of accuracy of SMRPs in serum and pleural fluid for the diagnosis of MPM were pooled using random effects models. Summary receiver operating characteristic curves were used to summarise overall test performance.

Results: The summary estimates of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic OR were 0.61, 0.87, 5.71, 0.43 and 14.43, respectively, for serum and 0.79, 0.85, 4.78, 0.30 and 19.50, respectively, for pleural fluid. It was also found that megakaryocyte potentiating factor in serum had a superior diagnostic accuracy compared with mesothelin for MPM.

Conclusions: SMRPs in both serum and pleural fluid are helpful markers for diagnosing MPM with similar diagnostic accuracy. The negative results of SMRP determinations are not sufficient to exclude non-MPM, and the positive test results indicate that further invasive diagnostic steps might be necessary for the diagnosis of MPM.

Keywords: RESPIRATORY MEDICINE (see Thoracic Medicine).

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Figures

Figure 1
Figure 1
Funnel graphs for the assessment of potential publication bias in soluble mesothelin family proteins in (A) serum and (B) pleural fluid for diagnosing malignant pleural mesothelioma. The funnel graph plots the log of the diagnostic OR (DOR) against the SE of the log of the DOR (an indicator of sample size). Each solid circle represents each study in the meta-analysis. The line in the centre indicates the summary DOR.
Figure 2
Figure 2
Forest plots of estimates of sensitivity and specificity for soluble mesothelin family proteins in (A) serum and (B) pleural fluid for diagnosing malignant pleural mesothelioma. The point estimates of sensitivity and specificity from each study are shown as solid circles. Error bars are 95% CIs. Numbers indicate the reference numbers of studies cited in the reference list.
Figure 3
Figure 3
Summary receiver operating characteristic (SROC) curves with 95% CIs for soluble mesothelin family proteins in (A) serum and (B) pleural fluid for diagnosing malignant pleural mesothelioma. Each solid circle represents each study in the meta-analysis. The size of each study is indicated by the size of the solid circle. The regression SROC curves summarise the overall diagnostic accuracy.
See this image and copyright information in PMC

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