Comparison of mesothelin and fibulin-3 in pleural fluid and serum as markers in malignant mesothelioma

Curr Opin Pulm Med. 2015 Jul;21(4):352-6. doi: 10.1097/MCP.0000000000000167.


Purpose of review: Malignant mesothelioma is an asbestos-induced, aggressive tumour, which frequently presents with pleural effusion. There are over 60 reported causes that can result in the development of a pleural effusion. Currently, there are no tumour biomarkers in widespread clinical use for the differential diagnosis of mesothelioma from other diseases. With the incidence of mesothelioma expected to continue to increase, it is timely to review the current status of effusion-based biomarkers for mesothelioma diagnosis.

Recent findings: The majority of recent studies have evaluated soluble mesothelin in effusions in a diagnostic setting for mesothelioma. However, at high specificity, the sensitivity of the assay is limited to approximately 60% at the time of diagnosis. There is considerable research effort directed toward the identification of new markers for mesothelioma through a variety of genomic, proteomic and immunomic based platforms. One of the few new biomarkers to be identified through a biomarker discovery pipeline and evaluated in pleural effusions is fibulin-3. Preliminary results on the diagnostic accuracy of fibulin-3 have been inconsistent.

Summary: To date, soluble mesothelin remains the best available biomarker for mesothelioma and a positive result is clinically useful in patients with pleural effusions in whom the diagnosis is uncertain.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Biomarkers, Tumor
  • Diagnosis, Differential
  • Extracellular Matrix Proteins
  • GPI-Linked Proteins
  • Humans
  • Lung Neoplasms*
  • Mesothelioma*
  • Mesothelioma, Malignant
  • Pleural Effusion* / diagnosis


  • Biomarkers, Tumor
  • EFEMP1 protein, human
  • Extracellular Matrix Proteins
  • GPI-Linked Proteins
  • mesothelin