É possível diferenciar derrames pleurais linfocíticos secundários a tuberculose ou linfoma através de variáveis clínicas e laboratoriais?

Antonângelo, Leila; Vargas, Francisco Suso; Genofre, Eduardo H.; Oliveira, Caroline Maris Neves de; Teixeira, Lisete R.; Sales, Roberto Moura

doi:10.1590/s1806-37132012000200006

Cited by 16 publications

(8 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A patient with an effusion of malignant aetiology had only a 3% (6/172) chance of having a high pfADA and 0% (0/172) chance of the effusion also being lymphocyte predominant. The ability of pfADA to act as a ‘rule in’ test for mTB was greatly improved by consideration of the predominant cell type, increasing the specificity from 91% in all cause effusions to 99% in lymphocytic effusions.Six cases (2 NSCLC and 4 MPM) of malignant cause effusions had a high pfADA, although five appeared to have a co-existent pleural infection In other studies, high pfADA values have been reported in lymphoma[ 11 , 19 , 20 ], although all lymphoma cases in our cohort had pfADA values of less than 35 IU/L. Differentiating between mTB and lymphoma can be challenging, and additional tests such as lymphocyte subset analysis may help to distinguish one from the other[ 21 ].…”

Section: Discussionmentioning

confidence: 93%

Pleural Fluid Adenosine Deaminase (Pfada) in the Diagnosis of Tuberculous Effusions in a Low Incidence Population

et al. 2015

View full text Add to dashboard Cite

IntroductionPrevious studies have assessed the diagnostic ability of pleural fluid adenosine deaminase (pfADA) in detecting tuberculous pleural effusions, with good specificity and sensitivity reported. However, in North Western Europe pfADA is not routinely used in the investigation of a patient with an undiagnosed pleural effusion, mainly due to a lack of evidence as to its utility in populations with low mycobacterium tuberculosis (mTB) incidence.MethodsPatients presenting with an undiagnosed pleural effusion to a tertiary pleural centre in South-West England over a 3 year period, were prospectively recruited to a pleural biomarker study. Pleural fluid from consecutive patients with robust 12-month follow up data and confirmed diagnosis were sent for pfADA analysis.ResultsOf 338 patients enrolled, 7 had confirmed tuberculous pleural effusion (2%). All mTB effusions were lymphocyte predominant with a median pfADA of 72.0 IU/L (range- 26.7 to 91.5) compared to a population median of 12.0 IU/L (range- 0.3 to 568.4). The optimal pfADA cut off was 35 IU/L, which had a negative predictive value (NPV) of 99.7% (95% CI; 98.2-99.9%) for the exclusion of mTB, and sensitivity of 85.7% (95% CI; 42.2-97.6%) with an area under the curve of 0.88 (95% CI; 0.732–1.000).DiscussionThis is the first study examining the diagnostic utility of pfADA in a low mTB incidence area. The chance of an effusion with a pfADA under 35 IU/L being of tuberculous aetiology was negligible. A pfADA of over 35 IU/L in lymphocyte-predominant pleural fluid gives a strong suspicion of mTB.

show abstract

Section: Discussionmentioning

confidence: 93%

Pleural Fluid Adenosine Deaminase (Pfada) in the Diagnosis of Tuberculous Effusions in a Low Incidence Population

et al. 2015

View full text Add to dashboard Cite

show abstract

“…The relative abundance of T lymphocytes, which orchestrate the inflammatory response to tuberculosis, induces an elevation in ADA levels, particularly noticeable in cases of TBP. Nonetheless, pleural lymphocytic infiltration secondary to lymphoma also leads to an increase in pleural effusion ADA levels, with 25–56% of lymphomatous pleural effusions demonstrating ADA levels above the standard TB cutoff [ 9 , 18 , 19 ]. ADA levels exceeding 40 IU/L are not exclusive to lymphoma, as similar elevations can also be observed in pleural effusion secondary to leukemia or multiple myeloma.…”

Section: Discussionmentioning

confidence: 99%

Features which discriminate between tuberculosis and haematologic malignancy as the cause of pleural effusions with high adenosine deaminase

Choe,

Shin,

Jeon

et al. 2024

Respir Res

View full text Add to dashboard Cite

Background Adenosine deaminase (ADA) is a useful biomarker for the diagnosis of tuberculous pleurisy (TBP). However, pleural effusions with high ADA can also be caused by other diseases, particularly hematologic malignant pleural effusion (hMPE). This study aimed to investigate the features that could differentiate TBP and hMPE in patients with pleural effusion ADA ≥ 40 IU/L. Methods This was a retrospective observational study of patients with pleural effusion ADA ≥ 40 IU/L, conducted at a Korean tertiary referral hospital with an intermediate tuberculosis burden between January 2010 and December 2017. Multivariable logistic regression analyses were performed to investigate the features associated with TBP and hMPE, respectively. Results Among 1134 patients with ADA ≥ 40 IU/L, 375 (33.1%) and 85 (7.5%) were diagnosed with TBP and hMPE, respectively. TBP and hMPE accounted for 59% (257/433) and 6% (27/433) in patients with ADA between 70 and 150 IU/L, respectively. However, in patients with ADA ≥ 150 IU/L, they accounted for 7% (9/123) and 19% (23/123), respectively. When ADA between 40 and 70 IU/L was the reference category, ADA between 70 and 150 IU/L was independently associated with TBP (adjusted odds ratio [aOR], 3.11; 95% confidence interval [CI], 1.95–4.95; P < 0.001). ADA ≥ 150 IU/L was negatively associated with TBP (aOR, 0.35; 95% CI, 0.14–0.90; P = 0.029) and positively associated with hMPE (aOR, 13.21; 95% CI, 5.67–30.79; P < 0.001). In addition, TBP was independently associated with lymphocytes ≥ 35% and a lactate dehydrogenase (LD)/ADA ratio < 18 in pleural effusion. hMPE was independently associated with pleural polymorphonuclear neutrophils < 50%, thrombocytopenia, and higher serum LD. A combination of lymphocytes ≥ 35%, LD/ADA < 18, and ADA < 150 IU/L demonstrated a sensitivity of 0.824 and specificity of 0.937 for predicting TBP. Conclusion In patients with very high levels of pleural effusion ADA, hMPE should be considered. Several features in pleural effusion and serum may help to more effectively differentiate TBP from hMPE.

show abstract

“…Of the 10 cases reviewed, 8 had lymphocyte-predominant (Ly+Aty-Ly >70%) exudative effusion, and 9 had a high level of ADA (>40 U/L). Although one-third of the PEL-LL cases had elevated serum LDH levels (>500 U/L), tuberculous pleural effusion was also often elevated to approximately 500 U/L ( 39 ). While sIL2R levels >2,000 U/L are an indicator of malignant lymphoma ( 40 ), only 2 of the 9 cases of PEL-LL had such high levels of sIL2R.…”

Section: Discussionmentioning

confidence: 99%

Primary Effusion Lymphoma-like Lymphoma Mimicking Tuberculous Pleural Effusion: Three Case Reports and a Literature Review

et al. 2023

View full text Add to dashboard Cite

Primary effusion lymphoma-like lymphoma (PEL-LL) is a rare lymphoma, localized in the body cavity without detectable tumor masses. Tuberculous pleural effusion is a form of extra pulmonary tuberculous. We herein report three cases of PEL-LL in patients with a history of pulmonary tuberculosis. Despite the presentation with lymphocyte predominance and high levels of adenosine deaminase, a notable characteristic of tuberculous pleural effusion, the patients were ultimately diagnosed with PEL-LL. Pleural fluid laboratory tests yield similar results for PEL-LL and tuberculous pleural effusion; therefore, cytological and immunophenotyping examinations are useful for their differential diagnosis and the determination of treatment.

show abstract

É possível diferenciar derrames pleurais linfocíticos secundários a tuberculose ou linfoma através de variáveis clínicas e laboratoriais?

Cited by 16 publications

References 20 publications

Pleural Fluid Adenosine Deaminase (Pfada) in the Diagnosis of Tuberculous Effusions in a Low Incidence Population

Pleural Fluid Adenosine Deaminase (Pfada) in the Diagnosis of Tuberculous Effusions in a Low Incidence Population

Features which discriminate between tuberculosis and haematologic malignancy as the cause of pleural effusions with high adenosine deaminase

Primary Effusion Lymphoma-like Lymphoma Mimicking Tuberculous Pleural Effusion: Three Case Reports and a Literature Review

Contact Info

Product

Resources

About