Role of cancer ratio and other new parameters in the differential diagnosis of malignant pleural effusion

Ren, Zenghua; Xu, Ling

doi:10.6061/clinics/2021/e2515

Cited by 4 publications

(7 citation statements)

References 15 publications

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“…In the BUFF cohort, the median (quartile) ages (in years) of TPE, MPE and PPE were 67 (44–76), 64 (57–72) and 65 (58–73), respectively. Similar to previous studies [ 10 , 12 , 23 – 26 ], increased CR was observed in the MPE patients.…”

Section: Resultssupporting

confidence: 90%

“…Compared with previous studies [ 10 , 23 – 25 , 28 , 30 ], our study has its strengths. The first strength is that we used two cohorts to investigate the diagnostic accuracy of CR.…”

Section: Discussionmentioning

confidence: 95%

“…In addition, serum LDH increases with the advancement of age [ 14 , 38 ]. Therefore, elderly patients have higher CR than young patients, and age should be considered when interpreting the diagnostic value of CR for MPE [ 23 ]. It is widely accepted that PPE patients have increased serum LDH, and TPE patients have increased pleural ADA.…”

Section: Discussionmentioning

confidence: 99%

“…Someone may argue that the direct factor that affects the diagnostic accuracy of CR may not be “age” but “the percentage of TPE among BPE.“ As shown in Table 3 , the age of included patients in each study becomes younger when the study includes only TPE as the control. Indeed, TPE patients in previous studies aged around 40 years old [ 10 , 23 – 25 , 28 – 30 ]. However, the median age of TPE patients in our study is around 70 years old, which is obviously higher than that in previous studies.…”

Section: Discussionmentioning

confidence: 99%

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Age affects the diagnostic accuracy of the cancer ratio for malignant pleural effusion

Huang¹,

Chen²,

Gu³

et al. 2023

BMC Pulm Med

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Background and objective Cancer ratio (CR), which is defined as serum lactate dehydrogenase (LDH) to pleural fluid adenosine deaminase (ADA) ratio, has been reported to be a useful diagnostic marker for malignant pleural effusion (MPE). Whether its diagnostic accuracy is affected by age remains unknown. This study aimed to investigate the effects of age on the diagnostic accuracy of CR. Methods The participants in this study were from a prospective cohort (SIMPLE cohort, n = 199) and a retrospective cohort (BUFF cohort, n = 158). All participants were patients with undiagnosed pleural effusion (PE). We used receiver operating characteristic (ROC) curves to evaluate the diagnostic accuracy of CR. The effect of age on the diagnostic accuracy of CR was investigated by adjusting the upper limit of age for participant enrolment. Results Eighty-eight MPE patients were verified in the SIMPLE cohort, and thirty-five MPE patients were verified in the BUFF cohort. The AUCs of CR in the SIMPLE and BUFF cohorts were 0.60 (95% CI: 0.52–0.68) and 0.63 (95% CI: 0.54–0.71), respectively. In both cohorts, the AUCs of CR decreased with the advancement of age. Conclusion Age can affect the diagnostic accuracy of CR for MPE. CR has limited diagnostic value in older patients. Key message Cancer ratio is a promising diagnostic marker for malignant pleural effusion. This study revealed that its diagnostic accuracy decreased in older patients. Its diagnostic accuracy is overestimated by previous studies using tuberculosis and pneumonia patients as controls.

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Section: Resultssupporting

confidence: 90%

“…Compared with previous studies [ 10 , 23 – 25 , 28 , 30 ], our study has its strengths. The first strength is that we used two cohorts to investigate the diagnostic accuracy of CR.…”

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Age affects the diagnostic accuracy of the cancer ratio for malignant pleural effusion

Huang¹,

Chen²,

Gu³

et al. 2023

BMC Pulm Med

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“…Lymphocytes exhibit enhanced proliferation and differentiation under TB antigen stimulation, leading to increased ADA levels. Conversely, in MPE, low ADA levels are observed due to suppressed immune function in cancer patients, resulting in reduced ADA activity in lymphocytes [ 34 ]. In this study, both serum ADA and pfADA were significantly higher in TPE patients than in patients with MPE, consistent with previous studies [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical significance of pleural fluid lactate dehydrogenase/adenosine deaminase ratio in the diagnosis of tuberculous pleural effusion

Zhao,

Zhang,

Zhang

et al. 2024

BMC Pulm Med

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Background Pleural fluid is one of the common complications of thoracic diseases, and tuberculous pleural effusion (TPE) is the most common cause of pleural effusion in TB-endemic areas and the most common type of exudative pleural effusion in China. In clinical practice, distinguishing TPE from pleural effusion caused by other reasons remains a relatively challenging issue. The objective of present study was to explore the clinical significance of the pleural fluid lactate dehydrogenase/adenosine deaminase ratio (pfLDH/pfADA) in the diagnosis of TPE. Methods The clinical data of 618 patients with pleural effusion were retrospectively collected, and the patients were divided into 3 groups: the TPE group (412 patients), the parapneumonic pleural effusion (PPE) group (106 patients), and the malignant pleural effusion (MPE) group (100 patients). The differences in the ratios of pleural effusion-related and serology-related indicators were compared among the three groups, and receiver operating characteristic curves were drawn to analyze the sensitivity and specificity of the parameter ratios of different indicators for the diagnosis of TPE. Results The median serum ADA level was higher in the TPE group (13 U/L) than in the PPE group (10 U/L, P < 0.01) and MPE group (10 U/L, P < 0.001). The median pfADA level in the TPE group was 41 (32, 52) U/L; it was lowest in the MPE group at 9 (7, 12) U/L and highest in the PPE group at 43 (23, 145) U/L. The pfLDH level in the PPE group was 2542 (1109, 6219) U/L, which was significantly higher than that in the TPE group 449 (293, 664) U/L. In the differential diagnosis between TPE and non-TPE, the AUC of pfLDH/pfADA for diagnosing TPE was the highest at 0.946 (0.925, 0.966), with an optimal cutoff value of 23.20, sensitivity of 93.9%, specificity of 87.0%, and Youden index of 0.809. In the differential diagnosis of TPE and PPE, the AUC of pfLDH/pfADA was the highest at 0.964 (0.939, 0.989), with an optimal cutoff value of 24.32, sensitivity of 94.6%, and specificity of 94.4%; this indicated significantly better diagnostic efficacy than that of the single index of pfLDH. In the differential diagnosis between TPE and MPE, the AUC of pfLDH/pfADA was 0.926 (0.896, 0.956), with a sensitivity of 93.4% and specificity of 80.0%; this was not significantly different from the diagnostic efficacy of pfADA. Conclusions Compared with single biomarkers, pfLDH/pfADA has higher diagnostic value for TPE and can identify patients with TPE early, easily, and economically.

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Differentiating malignant effusions from other exudative effusions by cancer ratio and cancer ratio plus

Eruku¹

2021

Int. J. Adv. Res. Med.

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Introduction: Tuberculosis, cancer, and parapneumonic effusion are the most typical causes of exudative effusions. A biochemical marker for tuberculosis is the presence of ADA in pleural fluid. Unfortunately, no good biomarker exists to help in the identification of malignant effusion. The purpose of this research was to evaluate the accuracy of using the Cancer ratio and the Cancer ratio plus for diagnosing malignant effusion. Material and Methods: Observational study of 100 people diagnosed with pleural effusion. Between January 2021 and October 2021, researchers gathered data from Dhanalakshmi Srinivasaan Medical College and Hospital in Siruvachur, Perambalur, and Tamil Nadu. On admission, clinical, radiological, and biochemical tests are performed. LDH, ADA, and lymphocyte count are recorded. Cancer ratio, cancer ratio plus, and future follow-up. Statistically linked with the ultimate diagnosis. Results: Malignant effusion has a much higher cancer incidence rate and cancer incidence rate plus. Malignant pleural effusion is favourable linked with cancer ratio and cancer ratio plus in multivariate logistic regression analysis. The cancer ratio exhibited a sensitivity of 94.1% and a specificity of 98.3% at a cutoff level of 20, whereas at a cutoff level of 30 the cancer ratio showed a sensitivity of 94.1% and a specificity of 95.6%. Conclusion: Both the cancer ratio and the cancer ratio plus may be computed from common biochemical tests; they are inexpensive, highly accurate, and easy to use as early warning indicators of malignancy. It can help doctors actively hunt for cancer, rather than just waiting it out or treating TB on a hunch.

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Role of cancer ratio and other new parameters in the differential diagnosis of malignant pleural effusion

Cited by 4 publications

References 15 publications

Age affects the diagnostic accuracy of the cancer ratio for malignant pleural effusion

Age affects the diagnostic accuracy of the cancer ratio for malignant pleural effusion

Clinical significance of pleural fluid lactate dehydrogenase/adenosine deaminase ratio in the diagnosis of tuberculous pleural effusion

Differentiating malignant effusions from other exudative effusions by cancer ratio and cancer ratio plus

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