Diagnostic value of adenosine deaminase in tuberculous pleural effusion: a meta-analysis

Goto, Masashi; Noguchi, Yoshinori; Koyama, Hiroshi; Hira, Kenji; Shimbo, Takuro; Fukui, Tsuguya

doi:10.1258/000456303766477011

Cited by 128 publications

(86 citation statements)

References 35 publications

(13 reference statements)

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“…Paired data from two studies did suggest that in a direct comparison the NAAT tests were more accurate than ADA, but this was predominantly influenced by a single, small study using an inadequate reference standard, which produced very low sensitivity and specificity estimates for ADA. 212 Two previous meta-analyses assessing ADA for detection of pleural infection also found ADA to perform well (Q-points of 93% from 31 studies 86 and 92.2% from 40 studies 189 ). Both reviews included case-control studies and per specimen data.…”

Section: Discussion: Test Accuracy In Pleural Tb Infectionmentioning

confidence: 88%

A systematic review of rapid diagnostic tests for the detection of tuberculosis infection

Dinnes¹,

Deeks²,

Kunst³

et al. 2007

Health Technol Assess

529

361

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Section: Discussion: Test Accuracy In Pleural Tb Infectionmentioning

confidence: 88%

A systematic review of rapid diagnostic tests for the detection of tuberculosis infection

Dinnes¹,

Deeks²,

Kunst³

et al. 2007

Health Technol Assess

529

361

View full text Add to dashboard Cite

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“…This cutoff value shows high efficiency in the classification of lymphocytic effusions (sensitivity: 87 to 100% and specificity: 81 to 97%). [19][20][21][22][23][24][25] Despite the high diagnostic sensitivity of ADA, its specificity is influenced by other clinical conditions and by the regional prevalence of tuberculosis. 26,27 In the present study, 13 (9%) patients with cancer presented an ADA activity higher than 40 U/L.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Laboratory Parameters in the Differential Diagnosis of Pleural Effusion Secondary to Tuberculosis or Cancer

Antonângelo

Vargas

Seiscento

et al. 2007

Clinics

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62(5):585-90. PURPOSE:To evaluate the clinical and laboratory characteristics of pleural effusions secondary to tuberculosis (TB) or cancer (CA). METHODS: A total of 326 patients with pleural effusion due to TB (n=182) or CA (n=144) were studied. The following parameters were analyzed: patient gender, age and pleural effusion characteristics (size, location, macroscopic fluid aspect, protein concentration, lactate dehydrogenase (DHL) and adenosine deaminase activity (ADA) and nucleated cell counts). RESULTS: Young male patients predominated in the tuberculosis group. The effusions were generally moderate in size and unilateral in both groups. Yellow-citrine fluid with higher protein (p < 0.001) levels predominated in effusions from the tuberculosis group (5.3 + 0.8 g/dL) when compared to the CA group (4.2 ± 1.0 g/dL), whereas DHL levels were more elevated in CA (1,177 ± 675 x 1,030 ± 788 IU; p = 0.003) than in TB. As expected, ADA activity was higher in the TB group (107.6 ± 44.2 x 30.6 ± 57.5 U/L; p < 0.001). Both types of effusions presented with high nucleated cell counts, which were more pronounced in the malignant group (p < 0.001). TB effusion was characterized by a larger percentage of leukocytes and lymphocytes (p < 0.001) and a smaller number of mesothelial cells (p = 0.005). Lymphocytes and macrophages were the predominant nucleated cell in neoplastic effusions. CONCLUSION: Our results demonstrate that in lymphocytic pleural exudate obtained from patients with clinical and radiological evidence of tuberculosis, protein and ADA were the parameters that better characterize these effusions. In the same way, when the clinical suspicion is malignancy, serous-hemorrhagic lymphocytic fluid should be submitted to oncotic cytology once this easy and inexpensive exam reaches a high diagnostic performance (≅ 80%). In this context, we suggest thoracocentesis with fluid biochemical and cytological examination as the first diagnostic approach for these patients.

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“…A total of ten eligible studies (in English) were identified [12][13][14][15][16][17][18][19][20][21]. To this list, we added two meta-analyses published as abstracts [22,23].…”

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confidence: 99%

“…To this list, we added two meta-analyses published as abstracts [22,23]. TABLE 2 lists the results of all 12 meta-analyses [12][13][14][15][16][17][18][19][20][21][22][23]. All were published within the past 5 years, and included a total of 513 diagnostic trials (with some overlap across meta-analyses).…”

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confidence: 99%

“…For example, meta-analyses on TB pleural effusion included studies that used a variety of reference tests, including clinical diagnoses, histopathology and response to anti-TB therapy [13,15,16]. In some situations, especially when using NATs, investigators often performed discrepant analyses because they believed that NAT was potentially more sensitive than the reference standard [14,16,17].…”

Section: Sources Of Bias In Diagnostic Researchmentioning

confidence: 99%

See 1 more Smart Citation

Tuberculosis diagnostics trials: do they lack methodological rigor?

Pai¹,

O’Brien²

2006

Expert Review of Molecular Diagnostics

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Diagnostic value of adenosine deaminase in tuberculous pleural effusion: a meta-analysis

Cited by 128 publications

References 35 publications

A systematic review of rapid diagnostic tests for the detection of tuberculosis infection

A systematic review of rapid diagnostic tests for the detection of tuberculosis infection

Clinical and Laboratory Parameters in the Differential Diagnosis of Pleural Effusion Secondary to Tuberculosis or Cancer

Tuberculosis diagnostics trials: do they lack methodological rigor?

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