Evaluating pleural ADA, ADA2, IFN-γ and IGRA for diagnosing tuberculous pleurisy

Keng, Li‐Ta; Shu, Chin‐Chung; Chen, Jason Yao-Ping; Liang, Sheng-Kai; Lin, Cheng Hsin; Chang, Li-Chien; Chang, Chia-Hao; Wang, Jann‐Yuan; Yu, Chong‐Jen; Lee, Lina

doi:10.1016/j.jinf.2013.05.009

Cited by 62 publications

(64 citation statements)

References 27 publications

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“…In five studies, every TPE patient had definite TB (17,21,22,29,36). In five other studies, Ͼ75% TPE patients had a similar definite diagnosis (Table 1) (19,24,27,31,35).…”

Section: Study Characteristicsmentioning

confidence: 90%

“…This reflects the real- life clinical decision-making scenario, where any "nonpositive" report is indicative of the absence of disease, more appropriately. This approach was adopted by a recent study, as well as by previous meta-analyses (6,12,19). The inclusion of indeterminate results in assessing sensitivity and the large sample size are major strengths of this analysis.…”

Section: Discussionmentioning

confidence: 99%

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Interferon Gamma Release Assays for Diagnosis of Pleural Tuberculosis: a Systematic Review and Meta-Analysis

et al. 2015

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The role of interferon gamma release assays (IGRAs), although established for identifying latent tuberculosis, is still evolving in the diagnosis of active extrapulmonary tuberculosis. We systematically evaluated the diagnostic performance of blood-and pleural fluid-based IGRAs in tuberculous pleural effusion (TPE). We searched the PubMed and Embase databases for studies evaluating the use of commercially available IGRAs on blood and/or pleural fluid samples for diagnosing TPE. The quality of the studies included was assessed through the QUADAS-2 tool. The pooled estimates of sensitivity and specificity with 95% confidence intervals (95% CI) were generated using a bivariate random-effects model and examined using forest plots and hierarchical summary receiver operating characteristic (HSROC) curves. Indeterminate IGRA results were included for sensitivity calculations. Heterogeneity was explored through subgroup analysis and meta-regression based on prespecified covariates. We identified 19 studies assessing the T.SPOT.TB and/or QuantiFERON assays. There were 20 and 14 evaluations, respectively, of whole-blood and pleural fluid assays, involving 1,085 and 727 subjects, respectively. There was only one good-quality study, and five studies used nonstandard assay thresholds. The pooled sensitivity and specificity for the blood assays were 0.77 (95% CI, 0.71 to 0.83) and 0.71 (95% CI, 0.65 to 0.76), respectively. The pooled sensitivity and specificity for the pleural fluid assays were 0.72 (95% CI, 0.55 to 0.84) and 0.78 (95% CI, 0.65 to 0.87), respectively. There was considerable heterogeneity; however, multivariate meta-regression did not identify any covariate with significant influence. There was no publication bias for blood assays. We conclude that commercial IGRAs, performed either on whole-blood or pleural fluid samples, have poor diagnostic accuracy in patients suspected to have TPE.T uberculosis (TB) is a common etiology of pleural effusion, especially in developing countries (1). A definitive microbiological diagnosis is achieved by tuberculous pleural effusion (TPE) in only a few patients, and the diagnostic accuracy of other pleural fluid investigations is suboptimal (1, 2). Estimation of adenosine deaminase or interferon gamma and detection of the mycobacterial genome in pleural fluid are used as diagnostic surrogates (2). Pleural biopsies may improve the diagnostic yield; however, these procedures are invasive, require expertise, and are not free from complications (3-5).In recent years, interferon gamma release assays (IGRAs) have emerged as an immunodiagnostic tool to detect tuberculous infection. IGRAs quantify interferon gamma released by T-lymphocytes in response to stimulation by specific antigens encoded in region of difference 1 (RD1) of the Mycobacterium tuberculosis genome. An enzyme-linked immunosorbent spot (ELISpot) assay (T-SPOT.TB; Oxford Immunotec Limited, United Kingdom) and an enzyme-linked immunosorbent assay (ELISA) (QuantiFERON; Cellestis Limited, Australia) are commercially avail...

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“…In five studies, every TPE patient had definite TB (17,21,22,29,36). In five other studies, Ͼ75% TPE patients had a similar definite diagnosis (Table 1) (19,24,27,31,35).…”

Section: Study Characteristicsmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Interferon Gamma Release Assays for Diagnosis of Pleural Tuberculosis: a Systematic Review and Meta-Analysis

et al. 2015

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“…The full text of the remaining 10 articles was examined, and one study (Losi et al, 2010) was excluded because it did not use the t-spot assay format. The final meta-analysis therefore included nine publications (Losi et al, 2007;Lee et al, 2009;Dheda et al, 2009;Kang et al, 2012;Keng et al, 2013;Liao et al, 2014;Zhang et al, 2014;Liu et al, 2013Liu et al, , 2014 TN = truly negative result; TP = truly positive result; FN = false-negative result; FP = false-positive result. a Enzymelinked immunospot assay (T-SPOT-TB; Oxford Immunotec Ltd., Oxford, UK) measuring the immune response to an ESAT-6 or CFP-10 peptide.…”

Section: Resultsmentioning

confidence: 99%

Accuracy of enzyme-linked immunospot assay for diagnosis of pleural tuberculosis: a meta-analysis

Li¹,

Qin²,

Li³

et al. 2015

Genet. Mol. Res.

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ABSTRACT. Current methods for diagnosing tuberculous pleurisy are poor. Some studies have explored the diagnostic value of a pleural effusion enzyme-linked immunospot (ELISPOT) assay, but its accuracy remains controversial. Therefore, we performed a meta-analysis of the existing evidence on the ability of the ELISPOT assay to diagnose tuberculous pleurisy. We systematically searched PubMed, Google Scholar, and EMBASE databases for studies measuring the sensitivity, specificity, and other measures of accuracy of the pleural effusion ELISPOT assay for diagnosis of tuberculous pleurisy. A total of nine studies were identified and subjected to meta-analysis, giving the following pooled values for sufficiently accurate to diagnose tuberculous pleurisy as a stand-alone technique. In fact, it appears to be superior to assays based on adenosine deaminase and gamma interferon for screening patients and confirming the diagnosis of tuberculous pleurisy.

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“…[3][4][5][6][7][8][9][10][11][12][13] The merits of using pfADA include its low cost, short turnaround time, and high sensitivity and specificity. 3,12 Notwithstanding possibly better sensitivity and specificity for detecting TBPE by combining ADA1 or ADA2 in pleural fluid (PF) with other PF biomarkers such as tumour necrosis factor-alpha, interleukin 27, interferon-gamma and dipeptidyl peptidase IV, [14][15][16][17] it may not be cost-effective to combine pfADA with other PF biomarkers. 18 Although ADA2 is predominantly increased in TBPE, and ADA1 is more commonly associated with pleural effusion due to pyogenic bacteria, 19 determination of ADA1 and ADA2 may not provide a diagnostic advantage over the use of total pfADA.…”

Section: Introductionmentioning

confidence: 99%

Optimising the utility of pleural fluid adenosine deaminase for the diagnosis of adult tuberculous pleural effusion in Hong Kong

Chan²,

Leung

et al. 2017

Hong Kong Med J

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Evaluating pleural ADA, ADA2, IFN-γ and IGRA for diagnosing tuberculous pleurisy

Cited by 62 publications

References 27 publications

Interferon Gamma Release Assays for Diagnosis of Pleural Tuberculosis: a Systematic Review and Meta-Analysis

Interferon Gamma Release Assays for Diagnosis of Pleural Tuberculosis: a Systematic Review and Meta-Analysis

Accuracy of enzyme-linked immunospot assay for diagnosis of pleural tuberculosis: a meta-analysis

Optimising the utility of pleural fluid adenosine deaminase for the diagnosis of adult tuberculous pleural effusion in Hong Kong

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