Mesothelioma laboratory tests

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]

Laboratory findings consistent with the diagnosis of mesothelioma include abnormal pleural fluid analysis (decreased pH and pleural fluid/serum glucose ratio). The presence of serum biomarkers such as soluble mesothelin (SM) and megakaryocyte potentiating factor (MPF) is suggestive of malignant mesothelioma. Additional laboratory tests include immunophenotypic analysis to identify cell lines of mesothelioma.

• Pleural fluid analysis, via thoracentesis, may be performed to help in the diagnosis of pleural mesothelioma.^[1]
• Pleural mesothelioma is associated with decreased pleural pH (< 7.30) and decreased pleural fluid/serum glucose ratios.
• Pleural fluid cytology may or may not be positive for mesothelioma.^[2]

The presence of serum biomarkers such as soluble mesothelin (SM) and megakaryocyte potentiating factor (MPF) is suggestive of malignant mesothelioma.^[3]

• All cell lines of mesothelioma express surface human leukocyte antigen (HLA) class I and intercellular adhesion molecule-1 (ICAM-1).^[4]
• Chromosome-6 abnormalities are commonly found in with mesothelioma cell lines with abnormal karyotypes.
• In addition these cell lines on immunophenotypic analysis may show:
  • Vimentin
  • Cytokeratin 8
  • Cytokeratin 18
  • Mesothelial antigen recognized by HBME-1 monoclonal antibody

• FISH may be helpful in the diagnosis of mesothelioma. It helps in distinguishing malignant mesothelioma from reactive mesothelial cells in effusions.^[5]
• Mutlitarget FISH assay may be used to detect chromosomal abberations (chromosomes 3, 7, 17, and 9p21).
• FISH technique may also be used to explore the alternative mechanism of tumor suppressor gene inactivation by methylation of p16, p14, and p15 gene in the pathogenesis of mesothelioma.^[5]

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