CLINICAL UTILITY OF LIQUID-CHROMATOGRAPHIC ANALYSIS OF EFFUSIONS FOR HYALURONATE CONTENT

A previously described HPLC method for determining hyaluronate in effu sions was used to analyze a consecutive series of effusions from 1039 patients with pleural fluids and from 571 patients with peritoneal flu ids. A mesothelioma was verified histologically in 50 of the cases. Th e results were used to estimate the clinical utility of the analysis. With a cutoff of 75 mg/L for hyaluronate-derived uronic acid, assay sp ecificity for a malignant mesothelioma was 100% and the sensitivity 56 %. Only 20% of the effusions from the mesothelioma patients showed no evidence of increased production of hyaluronate. Cytological smears fr om the associated cell pellets were evaluated as malignant or suspicio us for malignancy in only 28% or in a further 46% of the mesothelioma cases, respectively, leaving 30% of the pellets as cytologically false -negative. We also analyzed effusions from selected cases submitted fr om other hospitals, 154 of which had been diagnosed histologically as mesotheliomas. Concentrations of hyaluronate were increased in these c ases too, but a considerable proportion of the samples showed evidence of losses of hyaluronate; consequently, the sensitivity of the assay in these samples was lower.