Adenosine Deaminase Levels in Nontuberculous Lymphocytic Pleural Effusions

Lee, Gary; Rogers, June; Rodriguez, R. Michael; Miller, Kent D.; Light, Richard W.

doi:10.1378/chest.120.2.356

Cited by 131 publications

(99 citation statements)

References 29 publications

(41 reference statements)

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“…Many studies have suggested that pleural fluid adenosine deaminase (pfADA) is useful in the diagnosis of tuberculous pleural effusion (TBPE). [3][4][5][6][7][8][9][10][11][12][13] The merits of using pfADA include its low cost, short turnaround time, and high sensitivity and specificity. 3,12 Notwithstanding possibly better sensitivity and specificity for detecting TBPE by combining ADA1 or ADA2 in pleural fluid (PF) with other PF biomarkers such as tumour necrosis factor-alpha, interleukin 27, interferon-gamma and dipeptidyl peptidase IV, [14][15][16][17] it may not be cost-effective to combine pfADA with other PF biomarkers.…”

Section: Introductionmentioning

confidence: 99%

“…The test performance of pfADA has largely been evaluated by including all cases with pleural effusion, and estimating its sensitivity and specificity with reference to an optimal cut-off value. Some studies fine-tuned the test performance by restricting the analysis to subjects with lymphocytic exudates 9,13 or to young adults. 21 In Hong Kong, pfADA has been measured centrally by the Chemical Pathology Laboratory at the Princess Margaret Hospital using the Diazyme commercial kit.…”

Section: Introductionmentioning

confidence: 99%

“…Excluding patients with an early diagnosis of nontuberculous disease, notably malignancy and nontuberculous infection, may also help improve the utility of pfADA for TBPE. 5,9,[23][24][25][26] Diagnostic test accuracy depends on sensitivity and specificity, which are relatively stable, and pre-test probability that can be enhanced by selecting appropriate patients. In this study, we aimed to optimise its utility by increasing the pretest probability, and establish a local diagnostic pfADA cut-off value for adult TBPE.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Optimising the utility of pleural fluid adenosine deaminase for the diagnosis of adult tuberculous pleural effusion in Hong Kong

Chan²,

Leung

et al. 2017

Hong Kong Med J

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Optimising the utility of pleural fluid adenosine deaminase for the diagnosis of adult tuberculous pleural effusion in Hong Kong

Chan²,

Leung

et al. 2017

Hong Kong Med J

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“…It has been shown recently that ADA levels in nontuberculous lymphocytic pleural effusions seldom exceed the cut-off set for tuberculous effusions [6]. The purpose of this prospective study is to further assess the ADA levels in a larger series of nontuberculous lymphocytic pleural effusions.…”

mentioning

confidence: 98%

Diagnostic value of adenosine deaminase in nontuberculous lymphocytic pleural effusions

Castro¹,

Nuevo²,

Pérez-Rodríguez³

et al. 2003

Eur Respir J

128

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Adenosine deaminase (ADA) can aid in the diagnosis of tuberculous pleural effusions, but false-positive findings from lymphocytic effusions have been reported. The purpose of this study is to assess the ADA levels in nontuberculous lymphocytic pleural effusions (lymphocyte count w50%) of different aetiologies.Altogether, 410 nontuberculous lymphocytic pleural fluid samples were consecutively selected. These included malignant effusions (n=221), idiopathic effusions (n=76), parapneumonic effusions (n=35), postcoronary artery bypass graft surgery effusions (n=6), miscellaneous exudative effusions (n=21) and transudative effusions (n=51).The ADA level reached the diagnostic cut-off for tuberculosis (40 U?L -1 ) in seven of the 410 cases (1.71%). The negative predictive value of ADA for the diagnosis of pleural tuberculosis was 99% (403 of 407 cases) in the group of lymphocytic pleural effusions. In five of these seven patients ADA 1 and ADA 2 were measured, and in all these cases (100%) ADA 1 /ADA p correctly classified these lymphocytic effusions as nontuberculous (ratio v0.42).This prospective study provides additional evidence that adenosine deaminase levels in nontuberculous lymphocytic pleural effusions seldom exceed the cut-off set for tuberculous effusions. The pleural fluid adenosine deaminase levels were significantly higher in different types of exudative effusions than in transudates. An adenosine deaminase level v40 IU?L -1 virtually excluded a diagnosis of tuberculosis in lymphocytic pleural effusions. Adenosine deaminase 1 /adenosine deaminase p correctly classified all nontuberculous lymphocytic pleural effusions with high adenosine deaminase levels. Eur Respir J 2003; 21: 220-224.

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“…In such cases, the pleural fluid is an exudate with high levels of proteins, adenosine deaminase (ADA), and IFN-γ. (4)(5)(6)(7)(8)(9)(10)(11)(12) The methods that are currently used in order to diagnose pleural tuberculosis have problems, including low positivity rates in the direct testing for AFB, low sensitivity (20-30%), and delayed Mycobacterium tuberculosis growth in pleural fluid cultures. Although the presence of granulomas has been demonstrated in up to 80% of pleural tissue samples, (7)(8)(9) pleural biopsy is needed in order to establish the diagnosis.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2012

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Objective: To describe clinical and laboratory characteristics in patients with tuberculosis-related or lymphomarelated lymphocytic pleural effusions, in order to identify the variables that might contribute to differentiating between these diseases. Methods: This was a retrospective study involving 159 adult HIV-negative patients with tuberculosis-related or lymphoma-related lymphocytic effusions (130 and 29 patients, respectively), treated between October of 2008 and March of 2010 at the Pleural Diseases Outpatient Clinic of the University of São Paulo School of Medicine Hospital das Clínicas Heart Institute, in the city of São Paulo, Brazil. Results: Mean age and the mean duration of symptoms were lower in the tuberculosis group than in the lymphoma group. The levels of proteins, albumin, cholesterol, amylase, and adenosine deaminase (ADA) in pleural fluid, as well as the serum levels of proteins, albumin, and amylase, were higher in the tuberculosis group, whereas serum cholesterol and triglycerides were higher in the lymphoma group. Pleural fluid leukocyte and lymphocyte counts were higher in the tuberculosis group. Of the tuberculosis group patients, none showed malignant cells; however, 4 showed atypical lymphocytes. Among the lymphoma group patients, cytology for neoplastic cells was positive, suspicious, and negative in 51.8%, 24.1%, and 24.1%, respectively. Immunophenotyping of pleural fluid was conclusive in most of the lymphoma patients. Conclusions: Our results demonstrate clinical and laboratory similarities among the patients with tuberculosis or lymphoma. Although protein and ADA levels in pleural fluid tended to be higher in the tuberculosis group than in the lymphoma group, even these variables showed an overlap. However, none of the tuberculosis group patients had pleural fluid ADA levels below the 40-U/L cut-off point.Keywords: Pleural effusion; Tuberculosis; Lymphoma; Adenosine deaminase; Diagnosis, differential. ResumoObjetivo: Descrever características clínicas e laboratoriais em pacientes com derrames pleurais linfocíticos secundários a tuberculose ou linfoma, a fim de identificar as variáveis que possam contribuir no diagnóstico diferencial dessas doenças. Métodos: Estudo retrospectivo com 159 pacientes adultos HIV negativos com derrame pleural linfocítico secundário a tuberculose ou linfoma (130 e 29 pacientes, respectivamente) tratados no Ambulatório da Pleura, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo (SP), entre outubro de 2008 e março de 2010. Resultados: A média de idade e de duração dos sintomas foi menor no grupo tuberculose que no grupo linfoma. Os níveis pleurais de proteínas, albumina, colesterol, amilase e adenosina desaminase (ADA), assim como os níveis séricos de proteínas, albumina e amilase, foram maiores no grupo tuberculose, enquanto os níveis séricos de colesterol e triglicérides foram maiores no grupo linfoma. As contagens de leucócitos e linfócitos no líquido pleural foram maiores no grupo tub...

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Adenosine Deaminase Levels in Nontuberculous Lymphocytic Pleural Effusions

Cited by 131 publications

References 29 publications

Optimising the utility of pleural fluid adenosine deaminase for the diagnosis of adult tuberculous pleural effusion in Hong Kong

Optimising the utility of pleural fluid adenosine deaminase for the diagnosis of adult tuberculous pleural effusion in Hong Kong

Diagnostic value of adenosine deaminase in nontuberculous lymphocytic pleural effusions

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

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