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Novel biomarker analysis of pleural effusion enhances differentiation of tuberculous from malignant pleural effusion

Authors Chen K, Feng P, Chang C, Chen T, Chuang H, Lee C, Su C, Lin L, Lee K

Received 10 November 2015

Accepted for publication 17 February 2016

Published 11 June 2016 Volume 2016:9 Pages 183—189


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Kuan-Yuan Chen,1,2 Po-Hao Feng,1,2 Chih-Cheng Chang,1 Tzu-Tao Chen,1 Hsiao-Chi Chuang,1,3 Chun-Nin Lee,1,3 Chien-Ling Su,1,3 Lian-Yu Lin,4 Kang-Yun Lee,1,2

1Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, 2Department of Internal Medicine, School of Medicine, 3School of Respiratory Therapy, College of Medicine, Taipei Medical University, 4Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, Republic of China

Abstract: Lymphocytic pleurisy is commonly observed in tuberculosis and cancer. Noninvasive biomarkers are needed to distinguish tuberculous pleural effusion (TPE) from malignant pleural effusion (MPE) because current clinical diagnostic procedures are often invasive. We identified immune response biomarkers that can discriminate between TPE and MPE. Fourteen pleural effusion biomarkers were compared in 22 MPE patients and five TPE patients. Of the innate immunity biomarkers, the median levels of interleukin (IL)-1β and interferon-induced protein-10 (IP-10) were higher in TPE patients than in MPE patients (P<0.05 and P<0.01, respectively). Of the adaptive immunity biomarkers, the median levels of IL-13 and interferon-γ (IFN-γ) were higher in TPE patients than in MPE patients (P<0.05). In addition, the levels of basic fibroblast growth factor were higher in MPE patients than in TPE patients (P<0.05). Receiver operator characteristic analysis of these biomarkers was performed, resulting in the highest area under the curve (AUC) for IP-10 (AUC =0.95, 95% confidence interval, P<0.01), followed by IL-13 (AUC =0.86, 95% confidence interval, P<0.05). Our study shows that five biomarkers (IL-1β, IP-10, IFN-γ, IL-13, and basic fibroblast growth factor) have a potential diagnostic role in differentiating TPE from MPE, particularly in lung cancer-related MPE.

Keywords: biomarkers, tuberculous pleural effusion, lung cancer, malignant pleural effusion

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