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Updated: Feb 15, 2026

Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion
Published on: November 10, 2023
SHOX2 DNA methylation is a tumour marker in pleural effusions
Peter Ilse1, Stefan Biesterfeld, Natalia Pomjanski
1Institut für Pathologie, Schwerpunkt Cytopathologie, Heinrich-Heine-Universität, Moorenstr.5, 40225 Düsseldorf, Germany. Stefan.Biesterfeld@med.uni-duesseldorf.de.
Background:
The published sensitivity of cytological examination for malignant pleural effusions (MPE) ranges between 50% and 71%. The Epi proLung® BL Reflex Assay (Epigenomics AG, Berlin, Germany) has been reported as being highly sensitive and specific for lung cancer using bronchial aspirates. We hypothesize the assay to be of use in the detection of MPE.
Materials And Methods:
To test our hypothesis, we performed a retrospective cohort study on pleural effusion specimens of 1,270 patients (472 cases and 798 controls). The assay is based on quantification of methylated Short Stature Homeobox gene two (SHOX2) DNA in the specimen measured via multiplex real-time Polymerase Chain Reaction (PCR) on bisulfite-converted DNA.
Results:
Surprisingly, the assay detects metastases of lung cancer, as well as metastases of other malignant tumours. With a re-defined cut-off criterion, the test achieved a sensitivity of 39.5% with a specificity of 96.2%.
Conclusion:
This assay is able to detect MPE while not limited to the detection of lung cancer.
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