title: Diagnostic value of adenosine deaminase in tuberculous pleural effusion: a meta-analysis.
abstract: BACKGROUND
  Many studies have investigated the usefulness of adenosine deaminase activity (ADA) in pleural fluid for the early diagnosis of tuberculous pleurisy. To summarize the diagnostic characteristics of ADA we undertook a meta-analysis using a summary receiver operating characteristic (SROC) curve method.
  
  
  METHODS
  Data sources were MEDLINE (1966-1999), the Cochrane Library and bibliographies of review and original articles. Studies were included if the absolute numbers of true positive, false negative, true negative and false positive observations were available or could be derived from the data presented; gold standards were described explicitly; and the criteria for a positive ADA result were reported. We constructed an SROC curve based on these extracted data to estimate the test characteristics.
  
  
  RESULTS
  Forty articles were available for analysis. The gold standards used were pleural biopsy histology, microbiological examination of pleural fluid, pleural biopsy and sputum and the patient's clinical course or combinations of these. The sensitivity of ADA reported in the articles ranged from 47.1% to 100% and the specificity from 50.0% to 100%. The summary measure of test characteristics derived from the SROC curve was 92.2% for both sensitivity and specificity.
  
  
  CONCLUSIONS
  The test performance of ADA in tuberculous pleural effusion is reasonably good. Measurement of pleural ADA is thus likely to be a useful diagnostic tool for tuberculous pleurisy.
authors.affiliation: Department of General Medicine and Clinical Epidemiology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan. fkts@kuhp.kyoto-u.ac.jp
authors.forename: Masashi
authors.initials: M
authors.lastname: Goto
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Noguchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Koyama
authors.forename: Kenji
authors.initials: K
authors.lastname: Hira
authors.forename: Takuro
authors.initials: T
authors.lastname: Shimbo
authors.forename: Tsuguya
authors.initials: T
authors.lastname: Fukui
mesh_terms: D000243:Adenosine Deaminase / Q000032:analysis*; D006801:Humans; D010996:Pleural Effusion / Q000175:diagnosis*; D012372:ROC Curve; D014396:Tuberculosis, Pleural / Q000175:diagnosis*
chemical_list: D000243:Adenosine Deaminase