Role of Biomarkers for Predicting suspecting Malignant Mesothelioma in patients with Pleural Effusion presenting to a tertiary care hospital

Background: Diagnosis of malignant mesothelioma (MM) remains a challenge, especially in developing countries where resources in pathology are limited. The present study was aimed to evaluate cost-effective biomarkers to predict the probability of MM in biopsy samples in order to accelerate the diagnostic workup of the potential cases. Methods: We conducted a study at Pulmonology unit, Lady Reading Hospital Peshawar, Pakistan. Qualitative data (gender, frequency of biomarkers) was presented as frequency and percentage; while quantitative data (age) was presented as means and standard deviation. Results: Total of 81 cases were enrolled in the study. The median age was 55.04 years (range, 24–75 years) and 46 patients (56.8%) were males. Most of the cases (one fourth) were from age group above 50 years. Out of 81 suspected cases of MM, 53 (65%) were MM and 28(34.6%) were Metastatic Adeno-carcinoma (MA) as diagnosed by Abram’s close pleural biopsy. The most frequent marker present in MM case was Calretinine in 46 (86.8%), followed by WT1 and Cytokeratin in 45 (84.9%) cases each. Similarly the most commonly found marker in cases of MA was TTF1 in 22 (78.5%) cases. On the other hand TTF1 was absent in 100% cases of MM. Similarly Calretinine and HBME was absent in 26 (92.8%) cases of MA. One unresolved issue in this result was the presence of Cytokeratin among 42.8% cases of MA. Conclusion: This study shows that Calretinine, Cytokeratin, HBME and WT1 are useful marker that can enhance the speed and accuracy of diagnostic workup in case of suspected MM. More large scale and robust studies are needed to give guideline recommendations