P209 The clinical utility of pleural lymphocyte subset analysis in undiagnosed effusions: Abstract P209 Table 1.

Bhatnagar, Rahul; Clive, Amelia O; Zahan-Evans, Natalie; Morley, Anna; Pf, Virgo; Medford, Andrew R L; Harvey, John; Hooper, Clare; Otton, SH; Brett, Mary; Maskell, Nick A

doi:10.1136/thoraxjnl-2013-204457.361

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“…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 ]. A third of parapneumonic effusions had pfADA values of over 35 IU/L and in the case of empyema the result could be over 15 times the upper limit of normal.…”

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confidence: 51%

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

et al. 2015

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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.

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