Korean J Intern Med.  2022 Jan;37(1):137-145. 10.3904/kjim.2020.246.

Laboratory and radiological discrimination between tuberculous and malignant pleural effusions with high adenosine deaminase levels

• Lee J
• Park JE
• Choi SH
• Seo H
• Lee SY
• Lim JK
• Yoo SS
• Lee SY
• Cha SI
• Park JY
• Kim CH

• KMID: 2524249
• DOI: http://doi.org/10.3904/kjim.2020.246

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.

Keyword

Adenosine deaminase; Carcinoembryonic antigen; Malignant pleural effusions; Pleural nodularity; Pleural tuberculosis