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We report a case of middle-aged female presenting with mediastinal widening on chest radiograph owing to pleural effusion. The pleural effusion presenting as mediastinal widening on chest radiograph is rarely reported.

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INTRODUCTIONLung cancer has remained one of the commonest cancers and is the most important cause of cancer related deaths. 1 Symptoms in patients of lung cancer are non-specific and include persistent cough, haemoptysis, shortness of breath, chest pain and debility, which are also seen in many other non-malignant lung diseases. Commonly used investigations for the diagnosis of lung cancer are CT FNAC and bronchoscopy both being interventional. Despite the development of new treatment and therapies designed to increase the 5 year survival rate, lung cancer still remains the deadliest cancer.2 Screening with low dose computed tomography (LDCT) has been advocated but detection of false positive cases with it has been found to be upto 50%, as it also detects non-calcified ABSTRACT Background: Lung cancer screening is a challenge. Sputum cytology, chest X-ray, low dose computed tomography and other screening methods have not proved to be very effective. Serum biomarkers are a new hope in screening of lung cancer. The present study was planned to evaluate sensitivity and specificity of serum levels of amyloid A (SAA), soluble E-selectin (sE-selectin) and soluble E-cadherin (sE-cadherin) as lung cancer biomarkers. Methods: An observational and cross-sectional study comprised of three groups with 20 subjects each of proven lung cancer cases, patients with non-malignant respiratory diseases and healthy controls. Levels of SAA, sE-selectin and sE-cadherin were measured by solid phase sandwich ELISA. Individual and collective sensitivity and specificity of these biomarkers was analysed and cut off values calculated by receiver operating curves. Results: A statistically significant difference was found in the median levels (ng/ml) of SAA in patients of lung cancer, other non-malignant respiratory diseases, and healthy controls, the levels (Mean±SD) being 24980.50±6564.14,9961.10±2000.24 and 580.95±334.94 respectively in the three groups. A sensitivity of 80% and specificity of 55% was found when SAA levels of 1068 ng/ml were taken as cut off for screening of lung cancer. However, no significant difference was found in the serum levels of sE selectin and sE cadherin between the three groups. Moreover, significant association of biomarkers could also not be established with lung cancer when they were used in combination. Conclusions: In this preliminary report from India, SAA has been found to be a promising biomarker in screening for lung cancer.