Diagnostic performance of <i>SHOX2</i> and <i>RASSF1A</i> gene methylation assays in malignant pleural effusion: A systematic review and meta-analysis.

Abstract

e20058 Background: Malignant pleural effusion (MPE) is a common complication of advanced malignancies, often requiring palliative care. Differentiating MPE from benign pleural effusion (BPE) is crucial, as management strategies differ. Cytology and biopsy have limitations, highlighting the need for more sensitive and less invasive diagnostic techniques. This study aims to evaluate the diagnostic accuracy of methylated SHOX2 and RASSF1A genes in detecting MPE. Methods: This systematic review and meta-analysis included studies comparing BPE and MPE cohorts, with methylation of SHOX2 and RASSF1A genes in pleural fluid as the index test and cytology/histopathology as the reference standard. Diagnostic accuracy metrics were calculated using a random-effects model, including sensitivity, specificity, positive and negative predictive values, and diagnostic odds ratio. Subgroup analysis was performed to evaluate the index test's performance in lung-predominant versus non-lung-predominant MPE. Results: Four studies with a total of 534 participants were included. The pooled sensitivity and specificity were 85% (95% CI: 53-96%, I2= 0.00%) and 92% (95% CI: 88-95%, I2= 24.8%), respectively. The positive and negative predictive values were 93% (95% CI: 85-97%, I2= 61.5%) and 84% (95% CI: 53-96%, I2= 0.00%), respectively. The diagnostic odds ratio was 22.78 (95% CI: 11.00-47.17, I2= 28.8%). Subgroup analysis showed a slight decrease in sensitivity (70%, 95% CI: 64-76%, I2= 0.00%) and specificity (91%, 95% CI: 86-94%, I2= 26.1%) when excluding the study with a lung cancer-predominant population. Conclusions: The combined analysis of SHOX2 and RASSF1A methylation demonstrates promising diagnostic accuracy for MPE detection, outperforming cytology. This non-invasive approach could serve as a valuable adjunct to conventional methods, potentially reducing the need for more invasive procedures. Further research is warranted to assess its robustness across diverse patient populations and cancer types.