Clinical and Laboratory Parameters in the Differential Diagnosis of Pleural Effusion Secondary to Tuberculosis or Cancer

Abstract

62(5):585-90. PURPOSE:To evaluate the clinical and laboratory characteristics of pleural effusions secondary to tuberculosis (TB) or cancer (CA). METHODS: A total of 326 patients with pleural effusion due to TB (n=182) or CA (n=144) were studied. The following parameters were analyzed: patient gender, age and pleural effusion characteristics (size, location, macroscopic fluid aspect, protein concentration, lactate dehydrogenase (DHL) and adenosine deaminase activity (ADA) and nucleated cell counts). RESULTS: Young male patients predominated in the tuberculosis group. The effusions were generally moderate in size and unilateral in both groups. Yellow-citrine fluid with higher protein (p < 0.001) levels predominated in effusions from the tuberculosis group (5.3 + 0.8 g/dL) when compared to the CA group (4.2 ± 1.0 g/dL), whereas DHL levels were more elevated in CA (1,177 ± 675 x 1,030 ± 788 IU; p = 0.003) than in TB. As expected, ADA activity was higher in the TB group (107.6 ± 44.2 x 30.6 ± 57.5 U/L; p < 0.001). Both types of effusions presented with high nucleated cell counts, which were more pronounced in the malignant group (p < 0.001). TB effusion was characterized by a larger percentage of leukocytes and lymphocytes (p < 0.001) and a smaller number of mesothelial cells (p = 0.005). Lymphocytes and macrophages were the predominant nucleated cell in neoplastic effusions. CONCLUSION: Our results demonstrate that in lymphocytic pleural exudate obtained from patients with clinical and radiological evidence of tuberculosis, protein and ADA were the parameters that better characterize these effusions. In the same way, when the clinical suspicion is malignancy, serous-hemorrhagic lymphocytic fluid should be submitted to oncotic cytology once this easy and inexpensive exam reaches a high diagnostic performance (≅ 80%). In this context, we suggest thoracocentesis with fluid biochemical and cytological examination as the first diagnostic approach for these patients.

Age and sex distribution in malignant and tuberculous serous effusions: A study of 127 patients and review of the literature

“…According to Antony et al ., nearly all neoplasms have been reported to involve the pleura; however, lung carcinoma has been the most common neoplasm, followed by breast carcinoma and lymphomas; tumors less commonly associated with MPE include ovarian and gastrointestinal carcinomas . A review of the literature showed that clinical features, such as age, body temperature, weight loss and so on, act as supplementary features to the laboratory diagnostic parameters in differentiating malignant from tuberculous serous effusions involving pleural and peritoneal cavities . According to Villegas et al ., fever and younger age were associated with tuberculous pleural effusion (TPE; P < 0.0001), whereas blood in sputum and older age were associated with malignant etiology ( P < 0.008); these clinical variables together with the use of ADA activity, polymerase chain reaction and measurement of interferon‐γ levels provided the basis for rapid and efficient diagnosis of pleural tuberculosis in different clinical settings.…”

Diagnostic value of carbohydrate antigens in supernatants and sediments of pleural effusions

“…Diagnosis is normally carried out by invasive techniques, such as thoracoscopy, which show sensitivity but are not costeffective and induce physical and mental stress in the patient (8). The role of biochemical parameters or tumour markers were previously studied in order to increase the diagnostic capacity of pleural effusion analysis (9)(10)(11)(12)(13). The detection of these parameters or markers in bodily fluids is the result of a dynamic balance between the number of cells that synthesize the tumour marker, its capacity for synthesis and the amount eliminated by the organism relative to the nature, size and metabolic mechanism of the marker.…”

Evaluation of Adenosine Deaminase (ADA) Activity for Diagnosis of Tubercular Pleural Effusion

“…Out of the 103 cases, 62(60.1%) were tubercular pleural effusion cases and 49 (39.1%) were non-tubercular cases. Among the non-tubercular cases, 30 cases were due to malignancy, 8 were due to days) 7 . Direct analysis of pleural fluid for detection of acid-fast bacilli (AFB) by Ziehl-Neelsen (Z-N) or similar method is positive in less than 5% of cases and culture on Löwenstein-Jensen (L-J) medium does not surpass a 40% positivity rate.…”