To assess diagnostic utility of pleural fluid adenosine deaminase (ADA), interferon gamma (IFN), lymphocyte/neutrophil ratio (L/N) and its combination in differentiating tubercular and non-tubercular exudative pleural effusion

Abstract Purpose Extra-pulmonary tuberculosis occurs in about 10-20% of patients most commonly as tuberculous lymphadenitis or pleural effusion. Pleural fluid Adenosine deaminase (ADA) activity considered as a useful biomarker for detecting pleural tuberculosis. The purpose of this study was to evaluate the diagnostic accuracy of pleural fluid adenosine deaminase level in patients with pleural tuberculosis. Methods In this cross-sectional study, 113 patients with exudative pleural effusion with unknown underlying diagnosis, were enrolled. Physical examination, chest CT, measurement of ADA level of pleural fluid, direct thoracoscopic examination, and biopsy of pleura were performed for all individuals. Results The diagnosis of tuberculous pleurisy was established in 40 individuals regarding the pathology report of biopsy samples. The mean ADA level of the TB and the non-TB group was 39.90±22.93 IU/L and 30.74±38.27 IU/L respectively, which was not statistically significant (P-value=0.167). Sensitivity, specificity, positive predictive value, and negative predictive value of ADA test were 35%, 86.30%, 58.33%, and 70.79%, respectively. Conclusion Based on low sensitivity and specificity of ADA test, in patients with unexplained exudative pleural effusion especially in those who were suspicious for tuberculous pleurisy, despite the low level of ADA, direct thoracoscopic pleural observation and multiple biopsies of pleura is highly recommended.

Download Full-text

Diagnostic utility of pleural fluid carcinoembryonic antigen in patients with exudative pleural effusion

Lung India ◽

10.4103/lungindia.lungindia_196_20 ◽

2021 ◽

Vol 38 (2) ◽

pp. 139

Author(s):

AsmitaAnilkumar Mehta ◽

VishnuG Krishnan ◽

Akhilesh Kunoor ◽

Pavithran Keechilath

Keyword(s):

Pleural Effusion ◽

Carcinoembryonic Antigen ◽

Pleural Fluid ◽

Diagnostic Utility ◽

Exudative Pleural Effusion

Download Full-text

A clinical study of diagnostic efficacy of interferon gamma and adenosine deaminase in exudative pleural effusion

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20160835 ◽

2016 ◽

pp. 148-151

Author(s):

Lira Hakani ◽

Anila Mitre

Keyword(s):

Clinical Study ◽

Pleural Effusion ◽

Adenosine Deaminase ◽

Interferon Gamma ◽

Diagnostic Efficacy ◽

Exudative Pleural Effusion

Download Full-text

The relation of the pleural thickening in tuberculosis pleurisy with the activity of adenosine deaminase

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2005.646 ◽

2005 ◽

Vol 63 (2) ◽

Cited By ~ 2

Author(s):

B. Uskul ◽

H. Turker ◽

C. Ulman ◽

M. Ertugrul ◽

A. Selvi ◽

...

Keyword(s):

Pleural Effusion ◽

Adenosine Deaminase ◽

Pleural Fluid ◽

Clinical Findings ◽

X Rays ◽

Biochemical Tests ◽

Pleural Thickening ◽

Group I ◽

Immunological Mechanisms ◽

Tuberculosis Pleurisy

Selvi, A. Kant, S. Arslan, M. Ozgel. Background: Residual pleural thickening (RPT) still occurs in most patients with tuberculosis pleurisy despite advances in the treatment of tuberculosis. The aim of this study was to evaluate the significance of RPT in tuberculosis pleurisy with the patients clinical findings, biochemical and microbiological properties of pleural effusion and with the total adenosine deaminase (ADA) and isoenzymes levels. Methods: 121 tuberculosis pleurisy patients were evaluated retrospectively. According to posteroanterior chest x-rays, the 63 (52%) cases with the thickness 2 mm or more in lower lateral hemithorax were grouped as I and the 58 (48%) cases without pleural thickness were grouped as II. The amount of pleural effusion was classified into small, medium or massive according to their chest x-rays. In both groups; sex, age, symptoms score, bacteriological and biochemical tests and ADA levels were recorded. Results: 81 (67%) male and 40 (33%) female, overall 121 patients were enrolled into the study. RPT was found higher in males (p=0.014) and the increase ran parallel with the amount of cigarette smoking (p=0.014). RPT was found to be lower in small effusions (p=0.001). The group with RPT, the serum albumin was found lower (p=0.002), pleural fluid total protein (p=0.047) and the ratio of pleural fluid protein to serum protein (p=0.002) were found higher. In group I, total ADA: 69.5±38.9 IU/L and ADA2: 41.3±31.6 IU/L were higher than the cases without RPT (p=0.032, p=0.017, respectively). Conclusions: We suggest that the immunological mechanisms are effective in the development of pleural thickening.

Download Full-text

Diagnostic Value of Flexible Thoracoscopy in Undiagnosed Cases of Exudative Pleural Effusion

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2020/571 ◽

2020 ◽

Vol 7 (47) ◽

pp. 2783-2786

Author(s):

Vengada Krishnaraj S.P. ◽

Gayathri S. Mohan ◽

Vinod Kumar V ◽

Sridhar R

Keyword(s):

Pleural Effusion ◽

Pleural Fluid ◽

Complete Blood Count ◽

Diagnostic Yield ◽

Diagnostic Value ◽

Parietal Pleura ◽

Pleural Biopsy ◽

Cardiac Evaluation ◽

Exudative Pleural Effusion ◽

Fluid Cytology

BACKGROUND The diagnostic yield of thoracoscopy is 95 %, of pleural fluid cytology it is 62 % and of closed pleural biopsy is 44 %, in malignant effusion. We wanted to study the diagnostic utility of flexible thoracoscopy in undiagnosed exudative pleural effusion and compare the thoracoscopy findings with the histopathology results. METHODS The study was conducted in the Department of Respiratory Medicine, Government Stanley Medical College, Chennai, from January 2019 to January 2020. 40 patients were enrolled in this longitudinal observational study with moderate to massive effusion and were evaluated with pleural fluid aspiration and sent for cytology, protein sugar analysis, total count, and ADA. Those cases which are exudative pleural effusions, with ADA value of less than 40 IU / L were subjected to thoracoscopy after being evaluated for fitness for thoracoscopy with complete blood count, bleeding time, clotting time, sputum for AFB, ECG, pulse oximetry, cardiac evaluation and CT chest. RESULTS Thoracoscopy was done in 40 enrolled patients. In this study, biopsy was taken from the parietal pleura in all the cases. Of these 40 cases, 30 were male and 10 were female, that is 75 % males and 25 % females. The mean age of the study population was 43 ± 14.9. Patient with the lowest age in this study group was 18 years and highest was 71 years. 16 cases (40 %) presented with left sided pleural effusion. 24 cases (60 %) presented with right sided pleural effusion. 30 cases presented with massive effusion, and 10 cases with moderate effusion. Of the 40 cases, 27 cases presented with straw coloured pleural effusion. 13 cases were haemorrhagic effusion. Histopathologic examination showed 11 cases as malignant and 29 cases as non-malignant out of which 18 cases were of tuberculosis aetiology. Thoracoscopy revealed adhesions in 13 cases and mass lesion in 4 cases. Of the 4 mass lesions 3 came as malignant, normal pleura in 11 cases, 10 were non-malignant and 1 was malignant. Nodules were seen in 12 cases of which 7 came as malignant. Straw coloured effusion was seen in 27 cases, of which 2 were malignant. CONCLUSIONS The most important indication for thoracoscopy is exudative undiagnosed pleural effusion. The overall diagnostic yield in pleural fluid cytology is 62 % and blind pleural biopsy is 44 %. The diagnostic yield of thoracoscopy varies from 60 % to 97 % in various studies, whereas, in our study, it is 72.5 %. Visualization of the visceral and parietal pleura is another advantage, so that we can take biopsy from the abnormal areas. KEYWORDS Flexible Thoracoscopy, Undiagnosed Exudative Pleural Effusion

Download Full-text

Comparative accuracy of pleural fluid unstimulated interferon-gamma and adenosine deaminase for diagnosing pleural tuberculosis: A systematic review and meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0253525 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0253525

Author(s):

Ashutosh Nath Aggarwal ◽

Ritesh Agarwal ◽

Sahajal Dhooria ◽

Kuruswamy Thurai Prasad ◽

Inderpaul Singh Sehgal ◽

...

Keyword(s):

Systematic Review ◽

Diagnostic Accuracy ◽

Adenosine Deaminase ◽

Pleural Fluid ◽

Sensitivity And Specificity ◽

Interferon Gamma ◽

Meta Analysis ◽

Paired Data ◽

Ifn Γ ◽

Meta Regression

Objective We compared diagnostic accuracy of pleural fluid adenosine deaminase (ADA) and interferon-gamma (IFN-γ) in diagnosing tuberculous pleural effusion (TPE) through systematic review and comparative meta-analysis. Methods We queried PubMed and Embase databases to identify studies providing paired data for sensitivity and specificity of both pleural fluid ADA and IFN-γ for diagnosing TPE. We used hierarchical summary receiver operating characteristic (HSROC) plots and HSROC meta-regression to model individual and comparative diagnostic performance of the two tests. Results We retrieved 376 citations and included 45 datasets from 44 publications (4974 patients) in our review. Summary estimates for sensitivity and specificity for ADA were 0.88 (95% CI 0.85–0.91) and 0.91 (95% CI 0.89–0.92), while for IFN-γ they were 0.91 (95% CI 0.89–0.94) and 0.96 (95% CI 0.94–0.97), respectively. HSROC plots showed consistently greater diagnostic accuracy for IFN-γ over ADA across the entire range of observations. HSROC meta-regression using test-type as covariate yielded a relative diagnostic odds ratio of 2.22 (95% CI 1.68–2.94) in favour of IFN-γ, along with better summary sensitivity and specificity figures. No prespecified subgroup variable significantly influenced the summary diagnostic accuracy estimates. Conclusion Pleural fluid IFN-γ estimation has better diagnostic accuracy than ADA estimation for diagnosis of TPE.

Download Full-text