Pleural IFN-γ release assay combined with biomarkers distinguished effectively tuberculosis from malignant pleural effusion

Abstract

BackgroundTuberculosis (TB) remains a major public health concern on a global scale, especially in developing nations. So far, no formal guidelines are available for the diagnosis and treatment of tuberculosis pleurisy. The diagnosis of TB is worsened by the immense difficulty in differential determination of tuberculosis pleural effusion (TPE) and malignant pleural effusion (MPE). The purpose of this investigation is to assess the differential diagnostic efficiencies of the pleural IFN-γ release assay (IGRA) and widely-used biochemical parameters in the distinction analysis of TPE and MPE.MethodsA cohort of 222 patients with pleural effusion was examined, comprising of 143 TPE and 58 MPE patients. The patients were examined with IGRA, and the widely-used biomarkers in the pleural effusion and peripheral blood.ResultsOur results show that the TPE patients have significantly higher M. tuberculosis (Mtb) antigen-specific IFN-γ responses to ESAT-6 protein and peptide pool in the blood compared to MPE patients. TPE patients were also shown to have enriched Mtb antigen-specific IFN-γ responses in pleural effusion than in peripheral blood. Among the widely-used biomarkers, the adenosine deaminase (ADA) and carcinoembryonic antigen (CEA) in pleural effusion were better biomarkers with high sensitivity and specificity to discriminate TPE and MPE. In addition, pleural IGRA could not be affected by the pleural adhesion, and the applications of the pleural IGRA together with ADA and CEA provide a promising approach for the TPE and MPE differential identification.ConclusionsOur study proposes that the integration of pleural IGRA and ADA, CEA detection could add to more effective diagnosis stratagems in the discernment between TPE and MPE.

Rapid Decline of IFN-γ Spot-Forming Cells in Pleural Lymphocytes during Treatment in a Patient with Suspected Tuberculosis Pleurisy

“…It was previously reported that ELISPOT assay using pleural fluid showed higher sensitivity and specificity than those of ELISPOT using peripheral blood lymphocytes or ADA of pleural fluid [9,10].…”

“…It was previously reported that ELISPOT assay using pleural fluid showed higher sensitivity and specificity than those of ELISPOT using peripheral blood lymphocytes or ADA of pleural fluid [9,10]. Very recently, ELISPOT of pleural fluids was integrated into the strategy for a more effective diagnosis, especially in differentiating from malignant pleural effusion [11].…”

“…However, it was found that high background was explained by four to five times enrichment of Mycobacterium tuberculosis antigen-specific IFN-γ-producing cells in the pleural fluid compared with their levels in the peripheral blood from patients with TPE in parallel assays. Accordingly, an IGRA performed on pleural fluid mononuclear cells could provide an accurate, rapid diagnosis of TPE after proper subtraction of the background signal [9][10][11]. Until now, it has not been demonstrated if IGRA could reflect the therapeutic response or not.…”

Identification of differentially expressed miRNAs in differentiating benign from malignant pleural effusion

“…Various causes can lead to pleural effusion, and one type of effusion caused by tuberculous pleurisy was complicate and time-consuming to differentiate from the other type caused by cancer [20]. Tuberculosis caused Tuberculosis pleural effusion (TPE) is endemic especially in the developing countries [35], whereas malignant disease like lung cancer is another major factor of pleural effusion, namely malignant pleural effusion (MPE) [17,25].…”

“…The traditional methods to diagnose TPE are based on the microbiological analyses of M.tuberculosis in pleural fluid, sputum and pleural biopsy specimens [25]. MPE is characterized by the manifestation of neoplastic cells in the pleural region, and the golden standard diagnostic approach is cytology, which can be used to confirm 30-60% MPE in advanced disease stages [29].…”