Key result
Combining whole blood QFT-GIT with pleural ADA improved the specificity and positive predictive value for diagnosing tuberculous pleural effusion to 100%.
Why the study?
Does the combination of whole blood QFT-GIT and pleural ADA improve the diagnostic accuracy for differentiating tuberculous from malignant pleural effusion in patients with pleural effusions?
Observational (n=117)
Does the combination of whole blood QFT-GIT and pleural ADA improve the diagnostic accuracy for differentiating tuberculous from malignant pleural effusion in patients with pleural effusions?
Combining whole blood QFT-GIT with pleural ADA detection improves the specificity and positive predictive value for diagnosing tuberculous pleural effusion compared to either test alone.
May support higher diagnostic specificity for tuberculous pleural effusion; leaves open prospective validation before clinical adoption.
The differential diagnosis of tuberculous pleural effusion (TPE) and malignant pleural effusion (MPE) remains difficult despite the availability of numerous diagnostic tools. The current study aimed to evaluate the performance of the whole blood QuantiFERON-TB Gold In-Tube (QFT-GIT) assay and conventional laboratory biomarkers in differential diagnosis of TPE and MPE in high tuberculosis prevalence areas. A total of 117 patients with pleural effusions were recruited, including 91 with TPE and 26 with MPE. All of the patients were tested with QFT-GIT, and the conventional biomarkers in both blood and pleural effusion were detected. The level of antigen-stimulated QFT-GIT in the whole blood of TPE patients was significantly higher than that of MPE (2.89 vs 0.33 IU/mL, P<0.0001). The sensitivity and specificity of QFT-GIT for the diagnosis of TPE were 93.0% and 60.0%, respectively. Among the biomarkers in blood and pleural effusion, pleural adenosine deaminase (ADA) was the most prominent biomarker, with a cutoff value of 15.35 IU/L. The sensitivity and specificity for the diagnosis of TPE were 93.4% and 96.2%, respectively. The diagnostic classification tree from the combination of these two biomarkers was 97.8% sensitive and 92.3% specific. Ultimately, the combination of whole blood QFT-GIT with pleural ADA improved both the specificity and positive predictive value to 100%. Thus, QFT-GIT is not superior to pleural ADA in the differential diagnosis of TPE and MPE. Combined whole blood QFT-GIT and pleural ADA detection can improve the diagnosis of TPE.
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Liu et al. (2016) conducted an observational in Tuberculous pleural effusion (n=117). Combination of whole blood QuantiFERON-TB Gold In-Tube (QFT-GIT) assay and pleural adenosine deaminase (ADA) vs. Individual biomarkers (QFT-GIT alone or ADA alone) was evaluated on Differential diagnosis of tuberculous and malignant pleural effusion. Combining whole blood QFT-GIT with pleural ADA improved the specificity and positive predictive value for diagnosing tuberculous pleural effusion to 100%.
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