Combined evaluation of adenosine deaminase level and histopathological findings from pleural biopsy with Cope's needle for the diagnosis of tuberculous pleurisy.
BACKGROUND
Closed needle pleural biopsy (CNPB) has historically been the gold standard procedure for the diagnosis of pleural tuberculosis. Adenosine deaminase (ADA) is an efficient biomarker for tuberculosis that is measurable in pleural fluids.


OBJECTIVE
We compared the diagnostic accuracy of the pleural ADA (P-ADA) level and histopathological findings of CNPB specimens in patients with pleural tuberculosis.


METHODS
This prospective study consisted of two groups of examinations with a proven diagnosis of pleural effusion. The P-ADA level was measured in 218 patients with pleural effusion due to a number of causes, and 157 CNPB specimens underwent histopathological analysis.


RESULTS
CNPBs were performed in patients with tuberculosis (n=122) and other diseases: adenocarcinoma (n=23), lymphoma (n=5), systemic lupus erythematosus (n=4), squamous cell carcinoma (n=2), and small cell lung cancer (n=1). According to the ROC curve, the optimal cut-off value of the P-ADA level (Giusti and Galanti colorimetric method) was equal to or greater than 40.0 U/L. The diagnostic accuracy of the P-ADA test was 83.0%, and that of histopathological examination of the CNPB tissue, was 78.8% (AUC=0.293, P=0.7695). The association between the P-ADA assay and pleural histopathology was 24.41 (P<0.0001). The tetrachoric correlation coefficient was 0.563 (high correlation).


CONCLUSIONS
In Brazil and other countries with a high incidence of tuberculosis, P-ADA activity is an accurate test for the diagnosis of tuberculous pleural effusions, and its use should be encouraged. The high diagnostic performance of the P-ADA test could to aid the diagnosis of pleural tuberculosis and render CNPB unnecessary.
Department of Specialist Medicine, Federal University of The State of Rio de Janeiro Brazil.
Rodolfo Fred
RF
Behrsin
Department of Clinical Medicine, Universidade Federal Fluminense State of Rio de Janeiro, Brazil ; Pleurology Research Unit, Antonio Pedro University Hospital State of Rio de Janeiro, Brazil.
Cyro Teixeira da Silva
CT
Junior
Department of Clinical Medicine, Universidade Federal Fluminense State of Rio de Janeiro, Brazil ; Pleurology Research Unit, Antonio Pedro University Hospital State of Rio de Janeiro, Brazil.
Gilberto Perez
GP
Cardoso
Pleurology Research Unit, Antonio Pedro University Hospital State of Rio de Janeiro, Brazil.
Jorge Luiz
JL
Barillo
Pleurology Research Unit, Antonio Pedro University Hospital State of Rio de Janeiro, Brazil.
Joeber Bernardo Soares
JB
de Souza
Pleurology Research Unit, Antonio Pedro University Hospital State of Rio de Janeiro, Brazil.
Elizabeth Giestal
EG
de Araújo
D000243:Adenosine Deaminase / Q000032:analysis*; D000328:Adult; D019540:Area Under Curve; D015415:Biomarkers / Q000032:analysis; D001707:Biopsy, Needle; D004796:Clinical Enzyme Tests; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D000069258:Thoracentesis; D014396:Tuberculosis, Pleural / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology
D015415:Biomarkers; D000243:Adenosine Deaminase
Pleural effusion; adenosine deaminase; diagnosis; pleural biopsy; tuberculosis