{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T18:30:52Z","timestamp":1784140252336,"version":"3.55.0"},"reference-count":72,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2021,6,30]],"date-time":"2021-06-30T00:00:00Z","timestamp":1625011200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>For a number of patients presenting with an undiagnosed pleural effusion, frailty, medical co-morbidity or personal choice may preclude the use of pleural biopsy, the gold standard investigation for diagnosis of malignant pleural mesothelioma (MPM). In this review article, we outline the most recent evidence on ancillary diagnostic tests which may be used to support a diagnosis of MPM where histological samples cannot be obtained or where results are non-diagnostic. Immunocytochemical markers, molecular techniques, diagnostic biomarkers and imaging techniques are discussed. No adjunctive test has a sensitivity and specificity profile to support use in isolation; however, correlation of pleural fluid cytology with relevant radiology and supplementary biomarkers can enable an MDT-consensus clinico-radiological-cytological diagnosis to be made where further invasive tests are not possible or not appropriate. Diagnostic challenges surrounding non-epithelioid MPM are recognised, and there is a critical need for reliable and non-invasive investigative tools in this population.<\/jats:p>","DOI":"10.3390\/cancers13133291","type":"journal-article","created":{"date-parts":[[2021,6,30]],"date-time":"2021-06-30T10:03:19Z","timestamp":1625047399000},"page":"3291","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Ancillary Diagnostic Investigations in Malignant Pleural Mesothelioma"],"prefix":"10.3390","volume":"13","author":[{"given":"Alex","family":"Dipper","sequence":"first","affiliation":[{"name":"Academic Respiratory Unit, University of Bristol, Bristol BS105NB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick","family":"Maskell","sequence":"additional","affiliation":[{"name":"Academic Respiratory Unit, University of Bristol, Bristol BS105NB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Bibby","sequence":"additional","affiliation":[{"name":"Academic Respiratory Unit, University of Bristol, Bristol BS105NB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,6,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"i1","DOI":"10.1136\/thoraxjnl-2017-211321","article-title":"British Thoracic Society Guideline for the investigation and management of malignant pleural mesothelioma","volume":"73","author":"Woolhouse","year":"2018","journal-title":"Thorax"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1413","DOI":"10.1093\/carcin\/bgt166","article-title":"Molecular pathogenesis of malignant mesothelioma","volume":"34","author":"Sekido","year":"2013","journal-title":"Carcinogenesis"},{"key":"ref_3","first-page":"260","article-title":"Diffuse pleural mesothelioma and asbestos exposure in the North Western Cape Province","volume":"17","author":"Wagner","year":"1960","journal-title":"Br. J. Ind. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1183\/16000617.0063-2016","article-title":"Malignant pleural mesothelioma: An update on investigation, diagnosis and treatment","volume":"25","author":"Bibby","year":"2016","journal-title":"Eur. Respir. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1289\/ehp.1002285","article-title":"The Case for a Global Ban on Asbestos","volume":"118","author":"LaDou","year":"2010","journal-title":"Environ. Heal Perspect."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1136\/oemed-2017-104298","article-title":"Estimation of the global burden of mesothelioma deaths from incomplete national mortality data","volume":"74","author":"Odgerel","year":"2017","journal-title":"Occup. Environ. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1038\/ng.912","article-title":"P1 mutations predispose to malignant mesothelioma","volume":"43","author":"Testa","year":"2011","journal-title":"Nat. Genet."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1900953","DOI":"10.1183\/13993003.00953-2019","article-title":"ERS\/ESTS\/EACTS\/ESTRO guidelines for the management of malignant pleural mesothelioma","volume":"55","author":"Scherpereel","year":"2020","journal-title":"Eur. Respir. J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.1056\/NEJMra050152","article-title":"Advances in Malignant Mesothelioma","volume":"353","author":"Robinson","year":"2005","journal-title":"N. Engl. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"402","DOI":"10.3322\/caac.21572","article-title":"Mesothelioma: Scientific clues for prevention, diagnosis, and therapy","volume":"69","author":"Carbone","year":"2019","journal-title":"CA Cancer J. Clin."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1177\/0004563217741145","article-title":"Biomarkers in mesothelioma","volume":"55","author":"Arnold","year":"2018","journal-title":"Ann. Clin. Biochem"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.lungcan.2015.03.005","article-title":"Demographics, management and survival of patients with malignant pleural mesothelioma in the National Lung Cancer Audit in England and Wales","volume":"88","author":"Beckett","year":"2015","journal-title":"Lung Cancer"},{"key":"ref_13","first-page":"PA3085","article-title":"Diagnostic yield and safety of medical thoraco-scopic versus CT guided percutaneous tru-cut pleural biopsy","volume":"54","author":"Abouissa","year":"2019","journal-title":"Eur. Respir. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"II32","DOI":"10.1136\/thx.2010.136994","article-title":"Management of a malignant pleural effusion: British Thoracic Society pleural disease guideline 2010","volume":"65","author":"Roberts","year":"2010","journal-title":"Thorax"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1200\/JCO.2017.76.6394","article-title":"Treatment of Malignant Pleural Mesothelioma: American Society of Clinical Oncology Clinical Practice Guideline","volume":"36","author":"Kindler","year":"2018","journal-title":"J. Clin. Oncol"},{"key":"ref_16","unstructured":"Physicians RCo (2020). National Mesothelioma Audit Report 2020 (for the Audit Period 2016\u201318), National Mesothelioma Audit."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1016\/j.lungcan.2015.05.014","article-title":"Treatment patterns and survival analysis in 9014 patients with malignant pleural mesothelioma from Belgium, the Netherlands and England","volume":"89","author":"Damhuis","year":"2015","journal-title":"Lung Cancer"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e012092","DOI":"10.1136\/bmjopen-2016-012092","article-title":"What is the role of a specialist regional mesothelioma multidisciplinary team meeting? A service evaluation of one tertiary referral centre in the UK","volume":"6","author":"Bibby","year":"2016","journal-title":"BMJ Open"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"ii4-ii17","DOI":"10.1136\/thx.2010.136978","article-title":"Investigation of a unilateral pleural effusion in adults: British Thoracic Society pleural disease guideline 2010","volume":"65","author":"Hooper","year":"2010","journal-title":"Thorax"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1801254","DOI":"10.1183\/13993003.01254-2018","article-title":"Investigating unilateral pleural effusions: The role of cytology","volume":"52","author":"Arnold","year":"2018","journal-title":"Eur. Respir. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1753466618808660","DOI":"10.1177\/1753466618808660","article-title":"Biomarkers in the diagnosis of pleural diseases: A 2018 update","volume":"12","author":"Porcel","year":"2018","journal-title":"Ther. Adv. Respir. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1111\/cyt.12250","article-title":"Guidelines for the Cytopathologic Diagnosis of Epithelioid and Mixed-Type Malignant Mesothelioma: A secondary publication","volume":"26","author":"Hjerpe","year":"2015","journal-title":"Cytopathology"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1097\/PAP.0000000000000180","article-title":"Recent Advances in the Diagnosis of Malignant Mesothelioma: Focus on Approach in Challenging Cases and in Limited Tissue and Cytologic Samples","volume":"25","author":"Monaco","year":"2018","journal-title":"Adv. Anat. Pathol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"89","DOI":"10.5858\/arpa.2017-0124-RA","article-title":"Guidelines for Pathologic Diagnosis of Malignant Mesothelioma 2017 Update of the Consensus Statement From the International Mesothelioma Interest Group","volume":"142","author":"Husain","year":"2018","journal-title":"Arch. Pathol. Lab. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1097\/JTO.0b013e31823e0667","article-title":"Pleural Fluid Cytological Yield and Visceral Pleural Invasion in Patients with Epithelioid Malignant Pleural Mesothelioma","volume":"7","author":"Pinelli","year":"2012","journal-title":"J. Thorac. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"S3-S27","DOI":"10.21037\/tlcr.2019.11.29","article-title":"Application of immunohistochemistry in diagnosis and management of malignant mesothelioma","volume":"9","author":"Chapel","year":"2020","journal-title":"Trans. Lung Cancer Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.path.2010.03.010","article-title":"Benign and Malignant Mesothelial Proliferation","volume":"3","author":"Zeren","year":"2010","journal-title":"Surg. Pathol. Clin."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1046\/j.1365-2559.2003.01686.x","article-title":"The use of immunohistochemistry in distinguishing reactive from neoplastic mesothelium. A novel use for desmin and comparative evaluation with epithelial membrane antigen, p53, platelet-derived growth factor-receptor, P-glycoprotein and Bcl-2","volume":"43","author":"Attanoos","year":"2003","journal-title":"Histopathology"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"318","DOI":"10.5858\/arpa.2015-0240-SA","article-title":"New Markers for Separating Benign From Malignant Mesothelial Proliferations: Are We There Yet?","volume":"140","author":"Churg","year":"2016","journal-title":"Arch. Pathol. Lab. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1002\/dc.21398","article-title":"Diagnostic usefulness of EMA, IMP3, and GLUT-1 for the immunocytochemical distinction of malignant cells from reactive mesothelial cells in effusion cytology using cytospin preparations","volume":"39","author":"Ikeda","year":"2011","journal-title":"Diagn. Cytopathol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1309\/AJCPWFW7O1FVFLKT","article-title":"Usefulness of EMA, GLUT-1, and XIAP for the cytologic diagnosis of malignant mesothelioma in body cavity fluids","volume":"131","author":"Shen","year":"2009","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2017\/1310478","article-title":"Malignant Mesothelioma, BAP1 Immunohistochemistry, and VEGFA: Does BAP1 Have Potential for Early Diagnosis and Assessment of Prognosis?","volume":"2017","author":"Pulford","year":"2017","journal-title":"Dis. Markers"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"68863","DOI":"10.18632\/oncotarget.20317","article-title":"Diagnostic accuracy of BRCA1-associated protein 1 in malignant mesothelioma: A meta-analysis","volume":"8","author":"Wang","year":"2017","journal-title":"Oncotarget"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1097\/PAT.0b013e32835d0efb","article-title":"Tumours associated with BAP1 mutations","volume":"45","author":"Murali","year":"2013","journal-title":"Pathology"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1635","DOI":"10.1111\/cas.12769","article-title":"Deletion status of p16 in effusion smear preparation correlates with that of underlying malignant pleural mesothelioma tissue","volume":"106","author":"Hida","year":"2015","journal-title":"Cancer Sci"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.lungcan.2016.12.017","article-title":"Immunohistochemical detection of MTAP and BAP1 protein loss for mesothelioma diagnosis: Comparison with 9p21 FISH and BAP1 immunohistochemistry","volume":"104","author":"Hida","year":"2017","journal-title":"Lung Cancer"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/j.lungcan.2018.09.019","article-title":"A combination of MTAP and BAP1 immunohistochemistry is effective for distinguishing sarcomatoid mesothelioma from fibrous pleuritis","volume":"125","author":"Kinoshita","year":"2018","journal-title":"Lung Cancer"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1002\/cncy.21928","article-title":"A combination of MTAP and BAP1 immunohistochemistry in pleural effusion cytology for the diagnosis of mesothelioma","volume":"126","author":"Kinoshita","year":"2018","journal-title":"Cancer Cytopathol"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1038\/s41379-019-0310-0","article-title":"MTAP immunohistochemistry is an accurate and reproducible surrogate for CDKN2A fluorescence in situ hybridization in diagnosis of malignant pleural mesothelioma","volume":"33","author":"Chapel","year":"2020","journal-title":"Mod. Pathol"},{"key":"ref_40","first-page":"1060","article-title":"A gene-expression-based test can outperform bap1 and p16 analyses in the differential diagnosis of pleural mesothelial proliferations","volume":"19","author":"Bruno","year":"2020","journal-title":"Oncol. Lett."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.humpath.2018.05.012","article-title":"The diagnostic role of BAP1 in serous effusions","volume":"79","author":"Davidson","year":"2018","journal-title":"Hum. Pathol."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Selves, J., Long-Mira, E., Mathieu, M.-C., Rochaix, P., and Ili\u00e9, M. (2018). Immunohistochemistry for Diagnosis of Metastatic Carcinomas of Unknown Primary Site. Cancers, 10.","DOI":"10.3390\/cancers10040108"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.path.2019.10.001","article-title":"Diagnosis of Mesothelioma","volume":"13","author":"Fels","year":"2020","journal-title":"Surg. Pathol. Clin."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1093\/ejcts\/ezy258","article-title":"ERS\/EACTS statement on the management of malignant pleural effusions","volume":"55","author":"Bibby","year":"2019","journal-title":"Eur. J. Cardio-Thoracic Surg."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Ledda, C., Senia, P., and Rapisarda, V. (2018). Biomarkers for Early Diagnosis and Prognosis of Malignant Pleural Mesothelioma: The Quest Goes on. Cancers, 10.","DOI":"10.3390\/cancers10060203"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1612","DOI":"10.1016\/S0140-6736(03)14794-0","article-title":"Mesothelin-family proteins and diagnosis of mesothelioma","volume":"362","author":"Robinson","year":"2003","journal-title":"Lancet"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.chest.2016.12.004","article-title":"Malignant Mesothelioma Biomarkers: From Discovery to Use in Clinical Practice for Diagnosis, Monitoring, Screening, and Treatment","volume":"152","author":"Creaney","year":"2017","journal-title":"Chest"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e004145","DOI":"10.1136\/bmjopen-2013-004145","article-title":"Diagnostic values of soluble mesothelin-related peptides for malignant pleural mesothelioma: Updated meta-analysis","volume":"4","author":"Cui","year":"2014","journal-title":"BMJ Open"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"9532","DOI":"10.1200\/jco.2005.23.16_suppl.9532","article-title":"Soluble mesothelin related peptides: A potential biomarker for malignant pleural mesothelioma","volume":"23","author":"Pass","year":"2005","journal-title":"J. Clin. Oncol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1164\/rccm.200811-1729OC","article-title":"Clinical Impact and Reliability of Pleural Fluid Mesothelin in Undiagnosed Pleural Effusions","volume":"180","author":"Davies","year":"2009","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1183\/09031936.00148211","article-title":"A prospective trial evaluating the role of mesothelin in undiagnosed pleural effusions","volume":"41","author":"Hooper","year":"2013","journal-title":"Eur. Respir. J."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.cca.2014.02.024","article-title":"Diagnostic accuracy of osteopontin for malignant pleural mesothelioma: A systematic review and meta-analysis","volume":"433","author":"Hu","year":"2014","journal-title":"Clin. Chim. Acta"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1056\/NEJMoa1115050","article-title":"Fibulin-3 as a Blood and Effusion Biomarker for Pleural Mesothelioma","volume":"367","author":"Pass","year":"2012","journal-title":"New Engl. J. Med."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1136\/thoraxjnl-2014-205205","article-title":"Comparison of fibulin-3 and mesothelin as markers in malignant mesothelioma","volume":"69","author":"Creaney","year":"2014","journal-title":"Thorax"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1038\/bjc.2015.286","article-title":"Fibulin-3 levels in malignant pleural mesothelioma are associated with prognosis but not diagnosis","volume":"113","author":"Kirschner","year":"2015","journal-title":"Br. J. Cancer"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"84851","DOI":"10.18632\/oncotarget.12707","article-title":"Diagnostic value of fibulin-3 for malignant pleural mesothelioma: A systematic review and meta-analysis","volume":"7","author":"Ren","year":"2016","journal-title":"Oncotarget"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"13030","DOI":"10.18632\/oncotarget.14712","article-title":"Diagnostic and prognostic utilities of humoral fibulin-3 in malignant pleural mesothelioma: Evidence from a meta-analysis","volume":"8","author":"Pei","year":"2017","journal-title":"Oncotarget"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"e013324","DOI":"10.1136\/bmjopen-2016-013324","article-title":"Diagnostic and Prognostic Biomarkers in the Rational Assessment of Mesothelioma (DIAPHRAGM) study: Protocol of a prospective, multicentre, observational study","volume":"6","author":"Tsim","year":"2016","journal-title":"BMJ Open"},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Usuda, K., Iwai, S., Funasaki, A., Sekimura, A., Motono, N., Matoba, M., Doai, M., Yamada, S., Ueda, Y., and Uramoto, H. (2019). Diffusion-Weighted Imaging Can Differentiate between Malignant and Benign Pleural Diseases. Cancers, 11.","DOI":"10.3390\/cancers11060811"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"487","DOI":"10.2214\/ajr.154.3.2106209","article-title":"CT in differential diagnosis of diffuse pleural disease","volume":"154","author":"Leung","year":"1990","journal-title":"Am. J. Roentgenol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.rmed.2017.11.015","article-title":"Progress and challenges in Mesothelioma: From bench to bedside","volume":"134","author":"Blyth","year":"2018","journal-title":"Respir. Med."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.acra.2013.09.015","article-title":"Diagnostic accuracy of 18F-FDG-PET and PET\/CT in the differential diagnosis between malignant and benign pleural lesions: A systematic review and meta-analysis","volume":"21","author":"Treglia","year":"2014","journal-title":"Acad. Radiol."},{"key":"ref_63","unstructured":"DeFonseka, D. (2019, January 4\u20136). PET-CT in the Undiagnosed Effusion: Results of the TARGET Study. Proceedings of the British Thoracic Society Winter Meeting, London, UK."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.lungcan.2020.09.025","article-title":"A comparison between MRI and CT in the assessment of primary tumour volume in mesothelioma","volume":"150","author":"Tsim","year":"2020","journal-title":"Lung Cancer"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"225","DOI":"10.21873\/cgp.20183","article-title":"Putative Biomarkers for Malignant Pleural Mesothelioma Suggested by Proteomic Analysis of Cell Secretome","volume":"17","author":"Lacerenza","year":"2020","journal-title":"Cancer Genom. Proteom."},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Sage, A.P., Martinez, V.D., Minatel, B.C., Pewarchuk, M.E., Marshall, E.A., Macaulay, G.M., Hubaux, R., Pearson, D.D., Goodarzi, A.A., and Dellaire, G. (2018). Genomics and Epigenetics of Malignant Mesothelioma. High Throughput, 7.","DOI":"10.3390\/ht7030020"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1038\/modpathol.2016.188","article-title":"Genomic profiling of malignant peritoneal mesothelioma reveals recurrent alterations in epigenetic regulatory genes BAP1, SETD2, and DDX3X","volume":"30","author":"Joseph","year":"2017","journal-title":"Mod. Pathol."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Cakiroglu, E., and Senturk, S. (2020). Genomics and Functional Genomics of Malignant Pleural Mesothelioma. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21176342"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"9280170","DOI":"10.1155\/2017\/9280170","article-title":"Circulating miR-132-3p as a Candidate Diagnostic Biomarker for Malignant Mesothelioma","volume":"2017","author":"Weber","year":"2017","journal-title":"Dis. Markers"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"3123","DOI":"10.1007\/s00216-012-6432-6","article-title":"Metabonomic classification and detection of small molecule biomarkers of malignant pleural effusions","volume":"404","author":"Zhou","year":"2012","journal-title":"Anal. Bioanal. Chem."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1002\/cncy.21832","article-title":"Metabonomics by proton nuclear magnetic resonance in human pleural effusions: A route to discriminate between benign and malignant pleural effusions and to target small molecules as potential cancer biomarkers","volume":"125","author":"Zennaro","year":"2017","journal-title":"Cancer Cytopathol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.lungcan.2019.05.017","article-title":"Baseline predictors of negative and incomplete pleural cytology in patients with suspected pleural malignancy\u2014Data supporting \u2018Direct to LAT\u2019 in selected groups","volume":"133","author":"Tsim","year":"2019","journal-title":"Lung Cancer"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/13\/13\/3291\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:24:08Z","timestamp":1760163848000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/13\/13\/3291"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,30]]},"references-count":72,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2021,7]]}},"alternative-id":["cancers13133291"],"URL":"https:\/\/doi.org\/10.3390\/cancers13133291","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,30]]}}}