Differential Diagnosis of Tuberculous and Malignant Pleural Effusions: What is the Role of Adenosine Deaminase?

Abstract

The objective of this study was to evaluate the utility of invasive and noninvasive diagnostic procedures in tuberculous pleurisy (TPE) in an area with intermediate incidence of tuberculosis. The aim was to determine the cutoff value for adenosine deaminase (ADA) and the sensitivity and specificity of ADA and evaluate pleural fluid cytology and pleural biopsy in the differential diagnosis of malignant and tuberculous pleurisy. The study included 121 patients. TPE was confirmed in 54 patients and malignant effusion in 67 patients. Criteria used for TPE diagnosis were positive cultures of effusion or biopsy specimen, tuberculous granulomas, or positive sputum cultures without other explanation for pleural effusion. Malignancy was diagnosed by either cytology or biopsy. The cutoff value of ADA in TPE was 49 U/L, sensitivity was 89.2%, specificity was 70.4%, positive predictive value (PPV) was 84.4%, and negative predictive value (NPV) was 78.4%. ADA activity below 16 U/L suggests that TPE is highly unlikely with sensitivity=38.5%, specificity=100%, PPV=100%, and NPV=57.4%. ADA effusion/serum ratio reached a cutoff in TPE of 1.7 (sensitivity=84.6%, specificity=72.2%, PPV=81.4%, NPV=71.4%). Sensitivity, specificity, PPV, and NPV of cytology evaluation for TPE are 72.2%, 70.1%, 66.1%, and 75.8%, respectively. Pleuroscopy-guided pleural biopsy had sensitivity=66.7%, specificity=100%, PPV=100%, and NPV=78.8%. In 27.8% of TPE cases, pleural fluid cultures were positive. There is no doubt that pleuroscopy-guided biopsy is of great value for TPE diagnosis; however, sensitivity and specificity of noninvasive tests, especially ADA, can help to distinguish between TB and malignancy.

Tuberculosis in a developing country — how much patients know about disease

“…These results are not surprising, when the impact of smoking and abuse alcohol on the occurrence of tuberculosis is kept in mind, as confirmed by numerous studies [31][32][33][34][35][36][37][38]. This suggests another point for intensive education of a population at risk.…”

Adenosine deaminase activity in patients with ovarian neoplasms

“…The cut-off value of ADA in ascitic fluid as a diagnostic test for peritoneal tuberculosis is 39 IU/L [22]. In another study showed that ADA activity is important for differentiating tuberculosis from malignant pleural effusions [23]. In gynecology, peritoneal fluid ADA activities have been found to be useful in differentiating peritoneal TB and ovarian cancer [7][8][9]24].…”

Synovial fluid adenosine deaminase and high-sensitivity C-reactive protein activity in differentiating monoarthritis

“…Large body of evidence exists that ADA level in pleural, pericardial, peritoneal and cerebrospinal Xuid (CSF) can properly diVerentiate tuberculosis infection from other inXammatory causes in these body Xuids [3][4][5][6][7][8][9][10]. The ADA level in CSF is used to diagnose Listerial and Entroviral meningitis [11,12].…”