title: Clinical and laboratory parameters in the differential diagnosis of pleural effusion secondary to tuberculosis or cancer.
abstract: OBJECTIVE
  To evaluate the clinical and laboratory characteristics of pleural effusions secondary to tuberculosis (TB) or cancer (CA).
  
  
  METHODS
  A total of 326 patients with pleural effusion due to TB (n=182) or CA (n=144) were studied. The following parameters were analyzed: patient gender, age and pleural effusion characteristics (size, location, macroscopic fluid aspect, protein concentration, lactate dehydrogenase (DHL) and adenosine deaminase activity (ADA) and nucleated cell counts).
  
  
  RESULTS
  Young male patients predominated in the tuberculosis group. The effusions were generally moderate in size and unilateral in both groups. Yellow-citrine fluid with higher protein (p < 0.001) levels predominated in effusions from the tuberculosis group (5.3 + 0.8 g/dL) when compared to the CA group (4.2 +/- 1.0 g/dL), whereas DHL levels were more elevated in CA (1,177 +/- 675 x 1,030 +/- 788 IU; p = 0.003) than in TB. As expected, ADA activity was higher in the TB group (107.6 +/- 44.2 x 30.6 +/- 57.5 U/L; p < 0.001). Both types of effusions presented with high nucleated cell counts, which were more pronounced in the malignant group (p < 0.001). TB effusion was characterized by a larger percentage of leukocytes and lymphocytes (p < 0.001) and a smaller number of mesothelial cells (p = 0.005). Lymphocytes and macrophages were the predominant nucleated cell in neoplastic effusions.
  
  
  CONCLUSIONS
  Our results demonstrate that in lymphocytic pleural exudate obtained from patients with clinical and radiological evidence of tuberculosis, protein and ADA were the parameters that better characterize these effusions. In the same way, when the clinical suspicion is malignancy, serous-hemorrhagic lymphocytic fluid should be submitted to oncotic cytology once this easy and inexpensive exam reaches a high diagnostic performance (approximately equal 80%). In this context, we suggest thoracocentesis with fluid biochemical and cytological examination as the first diagnostic approach for these patients.
authors.affiliation: Service of Cytology of Division of the Central Laboratory- Hospital das Clínicas - University of São Paulo Medical School, São Paulo, Brazil. lantonangelo@hcnet.usp.br
authors.forename: Leila
authors.initials: L
authors.lastname: Antonangelo
authors.forename: Francisco Suso
authors.initials: FS
authors.lastname: Vargas
authors.forename: Marcia
authors.initials: M
authors.lastname: Seiscento
authors.forename: Sidney
authors.initials: S
authors.lastname: Bombarda
authors.forename: Lisete
authors.initials: L
authors.lastname: Teixera
authors.forename: Roberta Karla Barbosa de
authors.initials: RK
authors.lastname: Sales
mesh_terms: D000243:Adenosine Deaminase / Q000032:analysis*; D000328:Adult; D015415:Biomarkers / Q000032:analysis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000032:analysis*; D008175:Lung Neoplasms / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000175:diagnosis / Q000201:enzymology / Q000209:etiology*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014397:Tuberculosis, Pulmonary / Q000150:complications*
chemical_list: D015415:Biomarkers; D007770:L-Lactate Dehydrogenase; D000243:Adenosine Deaminase