Pleural effusion: Role of pleural fluid cytology, adenosine deaminase level, and pleural biopsy in diagnosis

Biswas, Biswajit; Sharma, Sudershan; Negi, R. S.; Gupta, Neelam; Jaswal, Virender M.S.; Niranjan, Narsimhalu

doi:10.4103/0970-9371.188062

Cited by 12 publications

(8 citation statements)

References 13 publications

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“…Although microscopy for acid‐fast bacilli in pleural fluid identifies TB in fewer than 10% of cases, this should be requested in patients with risk factors and high risk populations . High pleural fluid adenosine deaminase values are only helpful in differentiating tuberculous from malignant effusions in populations where TB is highly prevalent, or in developing countries, where access to pleural biopsy may be limited by inadequate healthcare resource or cost . Given that some cases of pleural malignancy can mimic pleural infection in their biochemical similarity of low pH and glucose, cytological analysis for cell count and differential is recommended in all cases of suspected pleural infection, with a minimum recommended fluid volume of 40‐50 mL …”

Section: Diagnosismentioning

confidence: 99%

“…49 High pleural fluid adenosine deaminase values are only helpful in differentiating tuberculous from malignant effusions in populations where TB is highly prevalent, or in developing countries, where access to pleural biopsy may be limited by inadequate healthcare resource or cost. 50 Given that some cases of pleural malignancy can mimic pleural infection in their biochemical similarity of low pH and glucose, cytological analysis for cell count and differential is recommended in all cases of suspected pleural infection, with a minimum recommended fluid volume of 40-50 mL. 51 Novel infection biomarkers such as CRP, procalcitonin and soluble triggering receptor expressed on myeloid cells (STREM-1) have been evaluated for their use in diagnosing pleural infection and aiding decision on chest tube drainage, but have not yet proven high diagnostic or prognostic value, and as such are not recommended in standard clinical practice.…”

Section: Pleural Fluid and Biomarkersmentioning

confidence: 99%

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Recent developments in the management of pleural infection: A comprehensive review

Bedawi

Hassan

Rahman

2018

Clinical Respiratory J

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Section: Diagnosismentioning

confidence: 99%

Section: Pleural Fluid and Biomarkersmentioning

confidence: 99%

Recent developments in the management of pleural infection: A comprehensive review

Bedawi

Hassan

Rahman

2018

Clinical Respiratory J

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“…Biswas B et al (32) found 77.8% of pleural effusions with ADA more than 40 U/L were diagnosed as tubercular effusion on pleural biopsy or culture or both, but 22.2% cases of biopsy proven tuberculosis had ADA levels less than 40 U/L. However, all patients with high ADA levels above 81 U/L were diagnosed as tubercular effusions.…”

Section: Discussionmentioning

confidence: 98%

Pleural Fluid Ada in the Diagnosis of Pleural Effusion

Duggal¹,

Yannawar²,

Dharmadhikari³

2017

jemds

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BACKGROUND Evaluation of pleural effusion is a common medical problem and despite the use of standard pleural fluid measurements and pleural biopsy the aetiology remains uncertain in a considerable number of cases. In our study, we assessed the importance of ADA activity in the diagnosis of pleural effusion. MATERIALS AND METHODS We studied 100 cases of pleural effusions of varying aetiology. Analysis of pleural fluid biochemistry cytology, ADA levels, ZN stain and results of pleural biopsy were analysed. This was a descriptive study. Statistical Analysis-Data were summarised using descriptive statistics such as percentages for categorical variables and mean with standard deviation for quantitative variables. For inferential statistics, two sample t-test was applied. A 'p' value of < 0.05 was considered significant. Sensitivity, specificity, positive predictive value and negative predictive values were calculated for using ADA as a screening test of TB pleural effusion. RESULTS We found Tubercular and Parapneumonic effusions in a younger age group (20-50 yrs.), whereas malignant effusions and those due to cardiac failure were found in an older subset (50-80 yrs.). Pleural biopsy positivity rate was 60%-80% in tuberculosis and 50%-85% in malignant effusions. ZN smear for AFB gave poor yield in sputum and pleural fluid. In all our patients, pleural fluid ADA was above 41.5 U/L with a mean value of 73.92 U/L. CONCLUSION Pleural fluid ADA in tubercular pleural effusion has a sensitivity, specificity, positive predictive value and negative predictive value at a cutoff of 41.5 U/L of 100%, 87%, 90%, 100% respectively.

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“…Histological and microbiological tests of tissue samples, such as culture and gram stain, are performed to ascertain the underlying cause(s) of empyema [15]. Previous studies have shown the very high diagnostic sensitivity of thoracoscopy to be as high as 95% in malignancy and 100% in benign diseases [14,19,20]. This shows the value of thoracoscopy in managing complicated cases of empyema that require surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

The Utility of Intraoperative Microbiological, Cytological, and Histopathological Sampling in the Setting of an Empyema Necessitating Lung Decortication Surgery

Niaz

Almas

Phelan

et al. 2020

Cureus

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Introduction and Aims: Empyema thoracis is a pleural space pathology that indicates accumulation of purulent material in the pleural space. It is often associated with an underlying infectious process, such as pneumonia, but can also be a ramification of a more sinister etiology, such as lung carcinoma, often warranting lung decortication surgery for prompt resolution. Although radiological imaging is used to form a preliminary diagnosis, its true predictive value remains questionable, and intraoperative microbiological, cytological, and histopathological samples are thus instrumental in yielding helpful diagnostic information. This study aims to gauge whether intraoperative microbiological, cytological, and histopathological analyses yield any additional diagnostic information in establishing the etiology underlying empyema, necessitating decortication surgery. Methods: Microbiological, cytological, and histopathological records of 43 patients undergoing decortication surgery were included in this study. Only patients who were diagnosed with late stages of empyema and subsequently underwent decortication surgery were included in this study. Results: The sample consisted of 43 patients, including 23 males and 20 females. For microbiology, 4.88% of the bronchoalveolar lavage (BAL) samples, 7.69% of tissue fluid samples, and 7.32% of pleural fluid samples were positive for an infectious microorganism. For cytology/histopathology, 0.00% of BAL samples, 5.41% of pleural fluid samples, and 7.32% of tissue samples were positive for an underlying infective etiology. Conclusion: For the study and analysis of the microbiological samples, a myriad of all three different modalities of diagnosis is essential. However, tissue sampling is the preferred modality of diagnosis for cytology/histopathology owing to its ability to detect positive cases that might otherwise evade prompt detection.

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Pleural effusion: Role of pleural fluid cytology, adenosine deaminase level, and pleural biopsy in diagnosis

Cited by 12 publications

References 13 publications

Recent developments in the management of pleural infection: A comprehensive review

Recent developments in the management of pleural infection: A comprehensive review

Pleural Fluid Ada in the Diagnosis of Pleural Effusion

The Utility of Intraoperative Microbiological, Cytological, and Histopathological Sampling in the Setting of an Empyema Necessitating Lung Decortication Surgery

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