|
KMID : 0338420220370010137
|
|
The Korean Journal of Internal Medicine
2022 Volume.37 No. 1 p.137 ~ p.145
|
|
|
Laboratory and radiological discrimination between tuberculous and malignant pleural effusions with high adenosine deaminase levels
|
|
Lee Jae-Hee
Park Ji-Eun
Choi Sun-Ha
Seo Hye-Won
Lee Sang-Yub
Lim Jae-Kwang
Yoo Seung-Soo
Lee Shin-Yup
Cha Seung-Ick
Park Jae-Yong
Kim Chang-Ho
|
|
|
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 fluid 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 fluid 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
|
|
|
FullTexts / Linksout information
|
|
|
|
|
Listed journal information
|
|
    
|
|