TNF-alpha in the Pleural Fluid for the Differential Diagnosis of Tuberculous and Malignant Effusion.
10.4046/trd.2005.59.6.625
- Author:
Hye Jin KIM
1
;
Kyeong Cheol SHIN
;
Jae Woong LEE
;
Kyu Jin KIM
;
Yeong Hoon HONG
;
Jin Hong CHUNG
;
Kwan Ho LEE
Author Information
1. Department of Internal Medicine, College of Medicine, Yeungnam University, Deagu, Korea. shin@med.yu.ac.kr
- Publication Type:Original Article
- Keywords:
Pleural effusion;
Malignancy;
Tuberculosis;
Tumor factor
- MeSH:
Biopsy;
Cytokines;
Diagnosis, Differential*;
Humans;
Pleural Effusion;
Pleural Effusion, Malignant;
Pleurisy;
Tuberculosis;
Tumor Necrosis Factor-alpha*
- From:Tuberculosis and Respiratory Diseases
2005;59(6):625-630
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Determining the cause of an exudative pleural effusion is sometimes quite difficult, especially between malignant and tuberculous effusions. Twenty percent of effusions remain undiagnosed even after a complete diagnostic evaluation, including pleural biopsy. The activity of tumor necrosis factor-alpha (TNF-alpha), which is the one of proinflammatory cytokines, is increased in both infectious and malignant effusions. The aim of this study was to investigate the diagnostic efficiency of TNF-alpha activity in distinguishing tuberculous from malignant effusions. METHODS: 46 patients (13 with malignant pleural effusion, 33 with tuberculous pleural effusion) with exudative pleurisy were included. TNF-alpha concentrations were measured in the pleural fluid and serum samples using an enzyme- linked immunosorbent assay (ELISA). In addition, TNF-alpha ratio (pleural fluid TNF-alpha : serum TNF-alpha) was calculated. RESULTS: TNF-alpha concentration and TNF-alpha ratio in the pleural fluid were significantly higher in the tuberculous effusions than in the malignant effusions (p<0.05). However, the serum levels of TNF-alpha in the malignant and tuberculous pleural effusions were similar (p>0.05). The cut off points for the pleural fluid TNF-alpha level and TNF-alpha ratio were found to be 136.4 pg/mL and 6.4, respectively. The sensitivity, specificity and area under the curve were 81%, 80% and 0.82 for the pleural fluid TNF-alpha level (p<0.005) and 76%, 70% and 0.72 for the TNF-alpha ratio (p<0.05). CONCLUSION: We conclude that pleural fluid TNF-alpha level and TNF-alpha ratio can distinguish a malignant pleural effusion from a tuberculous effusion, and can be additional markers in a differential diagnosis of tuberculous and malignant pleural effusion. The level of TNF-alpha in the pleural fluid could be a more efficient marker than the TNF-alpha ratio.
