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Mesothelioma Blood Test Early Detection

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Blood Test Early Detection
Prediagnostic Biomarker Testing for Mesothelioma
Category Medical / Diagnostic
FDA-Approved Test MESOMARK (SMRP) — cleared 2007
MESOMARK Sensitivity 61% pooled (28 studies)
Best Early Detection Window 15 months before diagnosis (mesothelin + calretinin)
SOMAmer Panel Accuracy 92% overall; 88% stage I/II detection
Three-Protein Panel AUC 0.99 (mesothelin + fibulin-3 + HMGB1)
Stage I Diagnosis Rate <5% of all mesothelioma patients
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Executive Summary

Mesothelioma blood test early detection is the most active frontier in mesothelioma research, driven by a stark clinical reality: fewer than 5% of patients are diagnosed at stage I, when surgery offers the best chance of long-term survival, and the median survival from diagnosis is approximately 12 months.[1][2] The only FDA-approved blood biomarker for mesothelioma is the MESOMARK assay, measuring soluble mesothelin-related peptides (SMRP), cleared in 2007 by Fujirebio Diagnostics for monitoring treatment response in confirmed patients — not for primary screening. A meta-analysis of 28 published studies established its pooled sensitivity at 61% and specificity at 87%, and while these figures are insufficient for standalone screening in the general asbestos-exposed population, MESOMARK remains the clinical benchmark against which newer biomarkers are compared.[3][4][5]

The most important recent finding on early detection comes from prediagnostic biomarker studies. A nested case-control study using blood samples collected from asbestos-exposed workers before any clinical diagnosis demonstrated that protein biomarkers — specifically mesothelin combined with calretinin — detected mesothelioma tumors up to 15 months before clinical diagnosis, achieving 46% sensitivity at 98% specificity.[6][7] This is the longest prediagnostic detection window documented for any single biomarker combination. By contrast, circulating microRNAs showed 0% sensitivity in samples collected a median of 8.9 months before diagnosis, making protein-based panels the leading approach for genuine early detection.[8][9]

The 13-protein SOMAmer panel represents the current gold standard for multi-biomarker classification accuracy. In blinded validation published from the landmark Ostroff et al. study, the SOMAmer classifier achieved 92% overall accuracy, detected 88% of stage I/II disease, and maintained an AUC of 0.95 in independent samples.[10][11] The DIAPHRAGM prospective study (Diagnostic and Prognostic Biomarkers in the Rational Assessment of Mesothelioma) was specifically designed to validate these markers in a high-risk asbestos-exposed cohort before diagnosis, providing the prospective evidence base needed to move panel testing toward clinical surveillance programs.[12][13]

The strongest single-protein biomarker data beyond mesothelin comes from fibulin-3 (serum AUC 0.94) and the hyperacetylated isoform of HMGB1 (100% sensitivity and specificity in an initial study of 22 patients, though with data integrity concerns). A three-protein panel of mesothelin, fibulin-3, and HMGB1 achieved an AUC of 0.99 with 96% sensitivity and 93% specificity. These multi-marker combinations, validated in at-risk asbestos-exposed populations, are reshaping how clinicians and researchers think about blood-based early detection — shifting from individual diagnostic thresholds to integrated risk classifiers that can identify high-probability cases warranting imaging follow-up years before symptoms emerge.[14][15][16][17]

At-a-Glance

Mesothelioma blood test early detection at a glance:

  • <5% diagnosed at stage I — the overwhelming majority of mesothelioma patients are diagnosed at stage III or IV, when surgical options are severely limited and median survival is measured in months[1]
  • MESOMARK: only FDA-approved blood test — cleared 2007 for treatment monitoring with 61% pooled sensitivity and 87% specificity across 28 studies; not approved for primary screening[3][4]
  • 15-month prediagnostic detection window — mesothelin combined with calretinin detected tumors in asbestos-exposed workers 15 months before clinical diagnosis with 46% sensitivity at 98% specificity[6]
  • SOMAmer 13-protein panel: 92% accuracy — the most accurate multi-marker classifier available, detecting 88% of stage I/II disease with AUC 0.95 in blinded validation[10]
  • Three-protein panel AUC 0.99 — mesothelin plus fibulin-3 plus HMGB1 achieved 96% sensitivity and 93% specificity, the highest combined performance of any tested combination[14]
  • Fibulin-3 serum AUC 0.94 — outperforms SMRP (AUC 0.81) and osteopontin (AUC 0.83) in head-to-head serum comparisons; plasma AUC drops to 0.69, making sample type critical[15]
  • HMGB1: 100% sensitivity/specificity in initial study — hyperacetylated isoform discriminated all 22 mesothelioma patients from 20 asbestos-exposed controls; an expression of concern was published in 2020 regarding data integrity[16]
  • MicroRNA: 0% prediagnostic sensitivity — circulating miRNAs failed to detect mesothelioma in samples collected a median 8.9 months before clinical diagnosis[8]
  • False positives from renal disease — both mesothelin and MPF are elevated in decreased kidney function independent of malignancy; a 10-year increase in age doubles the false-positive rate[18]
  • DIAPHRAGM study validates prediagnostic biomarkers — prospective study in high-risk asbestos-exposed cohort designed to establish clinical thresholds for blood-based surveillance[12]

Key Facts

Measure Finding (Source)
Only FDA-approved blood test MESOMARK assay (SMRP) — Fujirebio Diagnostics, cleared 2007 for treatment monitoring in confirmed patients[4][5]
MESOMARK pooled performance 61% sensitivity, 87% specificity, AUC 0.806 — meta-analysis of 28 studies[3]
Stage I diagnosis rate <5% of mesothelioma patients diagnosed at earliest, most treatable stage[1]
Median survival from diagnosis Approximately 12 months; underscores critical need for earlier blood-based detection[9]
Prediagnostic detection window Mesothelin + calretinin detected tumors 15 months before clinical diagnosis at 46% sensitivity, 98% specificity[6]
SOMAmer 13-protein panel 92% overall accuracy; 88% of stage I/II detected; AUC 0.95 in blinded validation — Ostroff et al. 2012[10]
Three-protein panel peak performance Mesothelin + fibulin-3 + HMGB1 achieved AUC 0.99, 96% sensitivity, 93% specificity[14]
Fibulin-3 serum AUC 0.94 in serum-based meta-analysis (87% sensitivity, 89% specificity) — outperforms SMRP and osteopontin[15]
Osteopontin performance 57% sensitivity, 81% specificity — meta-analysis of 10 studies; levels above 350 ng/mL predict median survival of 5 months[19]
HMGB1 initial study 100% sensitivity/specificity in 22 patients (expression of concern 2020); validates hyperacetylated isoform as distinct from full-length HMGB1[16]
MicroRNA prediagnostic failure 0% sensitivity in prediagnostic samples (median 8.9 months before diagnosis); protein markers outperform miRNA for early detection[8]
Age effect on false positives 10-year increase in age doubles false-positive mesothelin rate; kidney disease independently elevates SMRP and MPF regardless of malignancy[18]

What Makes Early Blood-Based Detection of Mesothelioma so Difficult?

Mesothelioma presents a uniquely difficult early detection challenge. The disease arises from the mesothelium — the lining of the lungs, abdomen, or heart — following asbestos fiber exposure that occurred 20 to 50 years earlier.[20] By the time symptoms such as chest pain or breathlessness drive a patient to seek care, the tumor has typically reached an advanced stage. This latency period also means the population at risk is identifiable in advance: workers with documented occupational asbestos exposure are the primary candidates for surveillance programs.[21][22]

The challenge for blood-based biomarkers is that tumor-shed proteins must reach measurable serum concentrations before the test can fire a signal. Mesothelin — the primary antigen measured by MESOMARK — is actively shed from the surface of mesothelioma tumor cells, and levels correlate with tumor volume. At early stage I disease, the tumor burden is small, and SMRP levels may remain below detection thresholds, explaining MESOMARK's 61% pooled sensitivity. A test with 39% false-negative rate would miss nearly four in ten early-stage cases, which is why researchers have focused on multi-protein panels that triangulate from multiple independent biological signals.[3][10][17]

False positives create the parallel problem. The clinical cost of a false positive in an asbestos-exposed population — unnecessary anxiety, invasive follow-up procedures including thoracentesis or biopsy — argues for high specificity even at the cost of some sensitivity. This trade-off between sensitivity and specificity is central to how clinical thresholds for MESOMARK and other markers are set, and it explains why any screening program will require a two-step approach: blood test signals warrant imaging follow-up (typically low-dose CT), not immediate invasive procedures.[18][7]

What Is the MESOMARK Assay and How Does It Work?

The MESOMARK assay measures soluble mesothelin-related peptides (SMRP) — a cleaved fragment of mesothelin, a glycoprotein highly overexpressed on the surface of malignant mesothelioma cells and shed into the bloodstream. MESOMARK was cleared by the FDA in 2007 under the Humanitarian Device Exemption (HDE) program for monitoring treatment response in patients with confirmed epithelioid or biphasic mesothelioma. It was developed and is commercialized by Fujirebio Diagnostics (formerly Mesomark/Bayer Diagnostics).[4][5][9]

The assay uses an enzyme-linked immunosorbent assay (ELISA) format and has an analytical sensitivity of 0.3 nM with a dynamic range extending to 26.69 nM. SMRP levels correlate directly with mesothelioma tumor volume, and serial measurements can track disease progression or treatment response without the radiation exposure of repeated CT imaging. In the FDA clearance studies, SMRP was shown to be elevated in patients with epithelioid and biphasic mesothelioma but typically not in sarcomatoid subtype, which is the rarest and most aggressive form.[4][13]

For early detection purposes, the limitations are clear: the pooled sensitivity of 61% across 28 studies means MESOMARK misses approximately 39% of mesothelioma cases at any stage. In prediagnostic studies, sensitivity at 95% specificity drops to 32%. However, when SMRP is combined with calretinin, the combined marker pair detects tumors up to 15 months before clinical diagnosis at 46% sensitivity and 98% specificity — the most clinically significant prediagnostic finding in the mesothelioma biomarker literature.[6][3][9]

How Do SOMAmer Protein Panels Improve Early Stage Detection?

The SOMAmer (slow off-rate modified aptamer) technology uses modified nucleic acid aptamers that bind to specific proteins with antibody-like affinity and selectivity. In 2012, Ostroff et al. published a landmark study in which a 13-protein SOMAmer classifier was trained and validated on serum samples from asbestos-exposed individuals, mesothelioma patients, and healthy controls.[10] The panel achieved:

  • 92% overall accuracy in validation
  • 88% detection of stage I and II disease — the most important early-detection metric
  • AUC of 0.99 in training and AUC of 0.95 in blinded validation
  • 93.2% sensitivity and 90.8% specificity in the full validation cohort

The 13 proteins in the classifier include markers of cellular stress, inflammation, extracellular matrix remodeling, and tumor microenvironment signaling — none of which are individually diagnostic, but which together form a biosignature highly specific to malignant mesothelioma. The use of an aptamer-based platform rather than antibody-based ELISA allows simultaneous measurement of dozens of proteins from a single small serum sample.[10][17]

The DIAPHRAGM study (Diagnostic and Prognostic Biomarkers in the Rational Assessment of Mesothelioma) was designed specifically to validate the SOMAmer panel and other emerging biomarkers prospectively in a high-risk asbestos-exposed cohort in the United Kingdom. Published in BMJ Open, the DIAPHRAGM study protocol established a framework for serial blood sampling in workers with documented asbestos exposure, providing the longitudinal evidence base needed to establish clinical thresholds before diagnosis.[12][7]

What Role Does Fibulin-3 Play in Mesothelioma Early Detection?

Fibulin-3 is a secreted extracellular matrix glycoprotein encoded by the EFEMP1 gene, first proposed as a mesothelioma biomarker in a 2012 New England Journal of Medicine study that reported extraordinary accuracy (96.7% sensitivity, 95.5% specificity) in distinguishing mesothelioma from asbestos-exposed controls and patients with other pleural diseases. Subsequent meta-analyses of multiple validation studies delivered more tempered but still clinically significant results.[15][13]

The comprehensive meta-analysis of fibulin-3 as a diagnostic biomarker for malignant pleural mesothelioma (PMC5356703) established:

  • Serum AUC: 0.94 (87% sensitivity, 89% specificity) — outperforms both SMRP (serum AUC 0.81) and osteopontin (serum AUC 0.83)
  • Plasma AUC: 0.69 — sample processing method has a major effect on accuracy; serum is the preferred matrix
  • Fibulin-3 is particularly elevated in pleural effusion fluid, where it may be more sensitive than serum measurements

The drop in AUC between serum and plasma results (0.94 versus 0.69) is a critical finding for any clinical application: laboratories must use serum, not plasma, for fibulin-3 measurement. This sample-type dependency explains some of the heterogeneity in published fibulin-3 studies and has been a barrier to standardization.[15][9]

When fibulin-3 is combined with mesothelin and HMGB1 in a three-protein panel, the combination achieves an AUC of 0.99 — near-perfect discrimination between mesothelioma and asbestos-exposed controls. This three-marker panel represents the highest-performing combination in the published literature and is the basis for ongoing efforts to create a standardized multi-marker blood test for surveillance of high-risk populations.[14][13]

What Is HMGB1 and Why Is Its Evidence Contested?

High mobility group box protein 1 (HMGB1) is an alarmin — a damage-associated molecular pattern (DAMP) molecule released from cells under conditions of stress, necrosis, and inflammation. In mesothelioma, hyperacetylated HMGB1 is actively secreted by tumor cells and by macrophages responding to asbestos fiber ingestion, making its detection in serum a potential early signal of asbestos-induced malignant transformation.[16][17]

The 2016 study by Napolitano et al. (PMC4867109) reported striking results: the hyperacetylated isoform of HMGB1 distinguished all 22 mesothelioma patients from 20 asbestos-exposed controls with 100% sensitivity and 100% specificity. The full-length (non-acetylated) form of HMGB1 showed similar performance. The hyperacetylated form was also detectable in asbestos-exposed workers without active malignancy, suggesting potential utility as a marker of malignant transformation risk.[16]

However, an expression of concern was published in Clinical Cancer Research in 2020 regarding data integrity issues in the mass spectrometry data contributed by one co-author of the 2016 study. This does not invalidate the biological rationale for HMGB1 as a biomarker or the mechanistic data in the study, but it means the 100% sensitivity/specificity claims require independent replication before they can be accepted as established fact. Potential confounders include alcoholic liver disease (which elevates hyperacetylated HMGB1 by a distinct phosphorylation pattern), and the small sample size (n=22) creates substantial risk of data overfitting.[17][13]

NCI Early Detection Research Network (EDRN) validation studies were proposed following the expression of concern. Until large-scale, independently replicated validation data are available, HMGB1 is best understood as a highly promising but not yet validated early detection biomarker.[17]

How Do False Positives Affect Blood Test Reliability for Early Detection?

The performance of mesothelioma blood biomarkers in early detection is significantly affected by confounding conditions that elevate protein levels independent of malignancy. Clinicians interpreting results in asbestos-exposed populations must account for the following established sources of false positives:[18][7]

Renal Disease

Both mesothelin/SMRP and megakaryocyte potentiating factor (MPF) — the other major cleaved mesothelin fragment — are elevated in patients with decreased kidney function. Glomerular filtration rate (GFR) is an independent predictor of SMRP and MPF concentrations, and patients with chronic kidney disease can produce mesothelin levels in the range typically associated with early mesothelioma. This is the single most clinically significant source of false positives and must be assessed before interpreting any SMRP result.[18][9]

Other Cancers

Mesothelin is overexpressed in pancreatic adenocarcinoma, ovarian carcinoma, and lung adenocarcinoma. An elevated SMRP result in an asbestos-exposed individual with a history of any of these cancers requires careful differential diagnosis. Osteopontin is elevated in colon, breast, prostate, and lung cancer — its 57% sensitivity for mesothelioma must be interpreted with awareness that many other malignancies produce the same signal.[19][7]

Age

A 10-year increase in age results in approximately 2-fold more false-positive mesothelin tests. Because the mesothelioma-at-risk population is predominantly older (consistent with the 20-to-50 year disease latency from occupational asbestos exposure), age-adjusted thresholds are needed for any practical surveillance program — the standard clinical cutoff values for SMRP established in younger populations systematically overestimate risk in elderly asbestos-exposed workers.[18][2]

Inflammatory Conditions

Hypertension, bronchitis, and elevated inflammatory markers can independently affect mesothelin concentrations. BMI also independently affects SMRP and calretinin levels. These covariates should be routinely recorded and accounted for in any surveillance protocol.[18]

What Biomarkers Can Detect Mesothelioma Before Symptoms Appear?

The critical question for blood-based early detection is not which markers perform best in diagnosed patients — it is which markers show elevated levels in asbestos-exposed individuals before clinical symptoms prompt evaluation. This distinction, between a diagnostic biomarker and a prediagnostic biomarker, is what separates markers useful for surveillance from those useful only for monitoring.[6][7]

The landmark prediagnostic study used blood samples from the Finnish Institute of Occupational Health biobank, drawn from asbestos-exposed workers who were later diagnosed with mesothelioma. Analysis of these prediagnostic samples demonstrated that mesothelin combined with calretinin detected tumors in samples collected up to 15 months before clinical diagnosis, at 46% sensitivity and 98% specificity. Calretinin — an intracellular calcium-binding protein overexpressed in mesothelioma cells and shed into blood — proved essential to the prediagnostic combination; mesothelin alone was insufficient at the prediagnostic stage.[6][9]

Circulating microRNAs, by contrast, showed 0% sensitivity in prediagnostic samples — completely failing to detect tumors in samples collected a median 8.9 months before clinical diagnosis. Individual miRNAs including miR-103a-3p achieve reasonable performance in established disease (83% sensitivity, 71% specificity), and when combined with mesothelin in diagnosed patients, sensitivity reaches 95%. But in the prediagnostic window — the only context where blood testing can genuinely affect outcomes by enabling earlier treatment — miRNAs provide no signal.[8][11]

This finding has direct clinical implications: surveillance programs in asbestos-exposed workers should focus on protein-based panels, not microRNA signatures, as the foundation of blood-based early detection. The 15-month prediagnostic window for the mesothelin-calretinin combination is shorter than ideal, but it opens a real opportunity: if high-risk workers are tested annually, this biomarker combination could identify malignant transformation at a point where surgical resection is more often feasible.[6][7][2]

Frequently Asked Questions

Can a blood test detect mesothelioma before symptoms appear?

Yes, protein-based biomarkers can detect mesothelioma before symptoms appear. The combination of mesothelin and calretinin detected mesothelioma tumors in prediagnostic blood samples collected up to 15 months before clinical diagnosis, achieving 46% sensitivity at 98% specificity. MicroRNA markers have failed in the same prediagnostic setting. Blood testing for early detection is most appropriate for individuals with documented occupational asbestos exposure who are enrolled in structured surveillance programs.[6][11]

What is the MESOMARK test and does it detect mesothelioma early?

MESOMARK is the only FDA-approved blood test for mesothelioma, measuring soluble mesothelin-related peptides (SMRP). It was cleared in 2007 by Fujirebio Diagnostics for monitoring treatment response in confirmed mesothelioma patients — not for primary screening or early detection. Its pooled sensitivity across 28 studies is 61%, meaning it misses approximately 39% of cases. In prediagnostic samples, sensitivity at 95% specificity drops to approximately 32%. MESOMARK is valuable for disease monitoring but requires additional biomarkers to achieve reliable early detection.[4][3][13]

Who should consider mesothelioma blood testing for early detection?

Individuals with documented occupational or secondary asbestos exposure are the primary candidates for blood-based mesothelioma surveillance. High-risk occupations include insulation workers, shipyard workers, construction workers, boilermakers, and industrial trades workers who worked with asbestos-containing materials before the 1980s. Blood biomarker testing is most useful as part of a structured surveillance program that combines annual or biennial blood testing with low-dose CT imaging, not as a one-time diagnostic test.[2][20][7]

What is the most accurate blood test for early-stage mesothelioma?

The SOMAmer 13-protein panel is the most accurate blood-based classifier for early-stage disease, detecting 88% of stage I and II mesothelioma with 92% overall accuracy and AUC of 0.95 in blinded validation. It outperforms all single-marker tests. However, it is not commercially available for clinical use outside of research settings. The three-protein panel of mesothelin, fibulin-3, and HMGB1 achieved an AUC of 0.99 but has not undergone large-scale independent validation. For clinical use today, MESOMARK remains the only commercially available and FDA-approved option.[10][14][11]

Why don't blood tests accurately detect mesothelioma at stage I?

At stage I, tumor burden is small and the quantity of protein shed into the bloodstream is correspondingly low. Mesothelin/SMRP levels at early stage may fall below detection thresholds or within the range of false positives from renal disease, age, and other cancers. Sensitivity improves significantly at later stages when tumor volume is larger — which is precisely backwards from what a useful screening test requires. Multi-protein panels that capture multiple independent signals are the most promising solution to this limitation.[3][10][7]

What is the DIAPHRAGM study and what did it find?

The DIAPHRAGM (Diagnostic and Prognostic Biomarkers in the Rational Assessment of Mesothelioma) study is a prospective cohort study of asbestos-exposed individuals in the United Kingdom, designed to validate blood-based biomarkers including the SOMAmer panel before clinical diagnosis. The study protocol, published in BMJ Open, established a framework for serial biomarker sampling in high-risk workers, providing the longitudinal evidence needed to set clinical thresholds for a surveillance-based screening program. DIAPHRAGM is specifically intended to address the gap between promising biomarker research in case-control studies and real-world clinical implementation.[12]

Can fibulin-3 detect mesothelioma before the MESOMARK test does?

Fibulin-3 in serum achieves an AUC of 0.94, outperforming SMRP (AUC 0.81) and osteopontin (AUC 0.83) in head-to-head serum comparisons. However, its prediagnostic performance — measured in blood drawn before clinical diagnosis — has not been as extensively documented as mesothelin-calretinin. Sample type matters critically: plasma fibulin-3 has an AUC of only 0.69, a significant drop from serum. For early detection programs, serum collection is mandatory, and fibulin-3 is best used in combination with mesothelin rather than as a standalone test.[15][11]

Quick Statistics

  • 12 months: median overall survival from mesothelioma diagnosis — the clinical cost of late-stage diagnosis[2]
  • <5%: proportion of mesothelioma patients diagnosed at stage I, when blood-based detection would have the greatest impact on outcome[1]
  • 15 months: the maximum prediagnostic detection window for the mesothelin-calretinin combination at 98% specificity[6]
  • 61%: MESOMARK pooled sensitivity across 28 studies — the clinical benchmark for newer biomarkers to exceed[3]
  • 88%: stage I/II mesothelioma detected by SOMAmer 13-protein panel — the highest early-stage detection rate in the literature[10]
  • 0.99: AUC for the three-protein panel (mesothelin + fibulin-3 + HMGB1) — the highest combined performance of any tested combination[14]
  • 0%: prediagnostic sensitivity of circulating microRNAs in samples collected median 8.9 months before clinical diagnosis[8]
  • 2x: increase in false-positive mesothelin results per 10-year increase in age[18]
  • 0.94 vs 0.69: fibulin-3 AUC in serum versus plasma — sample matrix is a decisive factor in biomarker accuracy[15]
  • 20-50 years: latency period from asbestos exposure to mesothelioma diagnosis, defining the at-risk surveillance window[20]

Get Help

If you or a loved one has a history of asbestos exposure or has received a mesothelioma diagnosis, legal help is available. Early diagnosis through blood-based surveillance may open surgical and clinical trial options not available at advanced stages.

  • Danziger & De Llano — National mesothelioma law firm offering free, confidential case evaluations. Call (866) 222-9990.
  • Mesothelioma Lawyers Near Me — Find experienced mesothelioma attorneys near you with free case review resources.


⚠ Statute of Limitations Warning: Filing deadlines vary by state from 1-6 years from diagnosis. Texas allows 2 years from diagnosis or discovery. Contact an attorney immediately to preserve your rights.

References

  1. ↑ 1.0 1.1 1.2 1.3 Mesothelioma Treatment — National Cancer Institute, National Cancer Institute
  2. ↑ 2.0 2.1 2.2 2.3 2.4 Mesothelioma Diagnosis, Danziger & De Llano
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Diagnostic Values of Soluble Mesothelin-Related Peptides for Mesothelioma: Meta-Analysis, BMJ Open 2014
  4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 MESOMARK Humanitarian Device Exemption — FDA Clearance Documentation, U.S. Food and Drug Administration
  5. ↑ 5.0 5.1 5.2 Fujirebio Diagnostics Receives FDA Approval for the MESOMARK Assay, Fujirebio Diagnostics
  6. ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 Calretinin as a Blood-Based Biomarker for Mesothelioma: A Prediagnostic Study, PMC / National Library of Medicine (Johnen et al. 2017)
  7. ↑ 7.0 7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8 Mesothelioma Diagnosis, Mesothelioma Lawyer Center
  8. ↑ 8.0 8.1 8.2 8.3 8.4 Are Circulating MicroRNAs Suitable for the Early Detection of Malignant Mesothelioma?, PMC / National Library of Medicine
  9. ↑ 9.0 9.1 9.2 9.3 9.4 9.5 9.6 Mesothelioma Blood Tests, Mesothelioma.net
  10. ↑ 10.0 10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8 Early Detection of Malignant Pleural Mesothelioma in Asbestos-Exposed Individuals Using SOMAmer Technology, PMC / National Library of Medicine (Ostroff et al. 2012)
  11. ↑ 11.0 11.1 11.2 11.3 11.4 Mesothelioma Blood Tests, Danziger & De Llano
  12. ↑ 12.0 12.1 12.2 12.3 Diagnostic and Prognostic Biomarkers in the Rational Assessment of Mesothelioma (DIAPHRAGM) — Study Protocol, BMJ Open
  13. ↑ 13.0 13.1 13.2 13.3 13.4 13.5 Mesothelioma Blood Tests and Biomarkers, Mesothelioma Lawyer Center
  14. ↑ 14.0 14.1 14.2 14.3 14.4 14.5 Identification of a New Potential Plasmatic Biomarker Panel for Mesothelioma Diagnosis, La Medicina del Lavoro
  15. ↑ 15.0 15.1 15.2 15.3 15.4 15.5 15.6 Diagnostic Value of Fibulin-3 for Malignant Pleural Mesothelioma: Meta-Analysis, PMC / National Library of Medicine
  16. ↑ 16.0 16.1 16.2 16.3 16.4 HMGB1 and Its Hyperacetylated Isoform Are Sensitive and Specific Serum Biomarkers to Detect Asbestos Exposure and Identify Mesothelioma Patients, PMC / National Library of Medicine
  17. ↑ 17.0 17.1 17.2 17.3 17.4 17.5 Mesothelioma Blood Tests, MesotheliomaAttorney.com
  18. ↑ 18.0 18.1 18.2 18.3 18.4 18.5 18.6 18.7 Re-evaluation of Potential Predictors of Calretinin and Mesothelin False Positives, PMC / National Library of Medicine
  19. ↑ 19.0 19.1 Performance of Osteopontin in the Diagnosis of Malignant Pleural Mesothelioma: A Meta-Analysis, PMC / National Library of Medicine
  20. ↑ 20.0 20.1 20.2 Toxicological Profile for Asbestos, Agency for Toxic Substances and Disease Registry
  21. ↑ Asbestos Exposure and Mesothelioma, Danziger & De Llano
  22. ↑ Asbestos Exposure, Mesothelioma Lawyer Center

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