The sensitivity of hyaluronan analysis of pleural fluid from patients with malignant mesothelioma and a comparison of different methods.

Abstract

Hyaluronan may be used as a marker for malignant mesothelioma, thus indicating its mesodermal origin. The sensitivity as a diagnostic test of three different methods for hyaluronan analyses of pleural fluid was examined in patients with biopsy-verified malignant pleural mesothelioma. A quantitative high-performance liquid-chromatography (HPLC) method was performed on fluids from 43 patients. Using a cutoff level of 100 mg/l, higher levels were noted in 30 (70%) patients, with a median value of 220 mg/l (mean, 560 mg/l; range, 20-6600 mg/l). An identical median value (220 mg/l) was obtained with a radioassay method when simultaneously performed on paired samples from 21 patients (correlation coefficient, 0.91). A qualitative precipitation test using 0.5% cetylpyridinium chloride combined with a quantitative viscosimetric method was significantly less sensitive (P < 0.01). Hyaluronan analyses is beneficial in distinguishing malignant mesothelioma if methods such as the evaluated HPLC or radioassay with a sensitivity of 70% toward mesothelioma are used and other known causes of elevated content are considered.