Laboratory and radiological discrimination between tuberculous and malignant pleural effusions with high adenosine deaminase levels
- Author:
Jaehee LEE
1
;
Ji Eun PARK
;
Sun Ha CHOI
;
Hyewon SEO
;
Sang Yub LEE
;
Jae Kwang LIM
;
Seung Soo YOO
;
Shin Yup LEE
;
Seung Ick CHA
;
Jae Yong PARK
;
Chang Ho KIM
Author Information
- Publication Type:2
- From:The Korean Journal of Internal Medicine 2022;37(1):137-145
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background/Aims:Pleural fluid adenosine deaminase (ADA) levels are useful in discriminating tuberculous pleural effusions (TPEs) from malignant pleural effusions (MPEs). However, some patients with MPE exhibit high-ADA levels, which may mimic TPEs. There is limited data regarding the differential diagnosis between high-ADA MPE and high-ADA TPE. This study aimed to identify the predictors for distinguishing high-ADA MPEs from high-ADA TPEs.
Methods:Patients with TPE and MPE with pleural f luid ADA levels ≥ 40 IU/L were included in this study. Clinical, laboratory, and radiological data were compared between the two groups. Independent predictors and their diagnostic performance for high-ADA MPEs were evaluated using multivariate logistic regression analysis and receiver operating characteristic curve.
Results:A total of 200 patients (high-ADA MPE, n = 30, and high-ADA TPE, n = 170) were retrospectively included. In the multivariate analysis, pleural fluid ADA, pleural f luid carcinoembryonic antigen (CEA), and pleural nodularity were independent discriminators between high-ADA MPE and high-ADA TPE groups. Using pleural ADA level of 40 to 56 IU/L (3 points), pleural CEA level ≥ 6 ng/mL (6 points), and presence of pleural nodularity (3 points) for predicting high-ADA MPEs, a sum score ≥ 6 points yielded a sensitivity of 90%, specificity of 96%, positive predictive value of 82%, negative predictive value of 98%, and area under the receiver operating characteristic curve of 0.965.
Conclusions:A scoring system using three parameters may be helpful in guiding the differential diagnosis between high-ADA MPEs and high-ADA TPEs.
