Evaluation of a diagnostic flow chart applying medical thoracoscopy, adenosine deaminase and T-SPOT.TB in diagnosis of tuberculous pleural effusion.
OBJECTIVE
To evaluate a diagnostic flow chart applying medical thoracoscoy (MT), adenosine deaminase (ADA) and T-SPOT.TB in diagnosis of tuberculous pleural effusion (TPE) at a high TB burden country.


METHODS
136 patients with pleural effusion (PE) were enrolled and divided into TPE and Non-TPE group. MT (histology), PE ADA and T-SPOT.TB were conducted on all patients. ROC analysis was performed for the best cut-off value of PE ADA in detection of TPE. The diagnostic flow chart applying MT, ADA and T-SPOT.TB was evaluated for improving the limitations of each diagnostic method.


RESULTS
ROC analysis showed that the best cut-off value of PE ADA was 30U/L. The sensitivity and specificity of these tests were calculated respectively to be: 71.4% (58.5%-81.6%) and 100% (95.4-100.0%) for MT, 92.9% (83.0-97.2%) and 68.8% (57.9-77.9%) for T-SPOT.TB, and 80.0% (69.6-88.1%) and 92.9% (82.7-98.0%) for PE ADA. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value and negative predictive value of the diagnostic flow chart were 96.4% (87.9-99.0%), 96.3% (89.6-98.7%), 25.714, 0.037, 97.4 and 94.9, respectively.


CONCLUSIONS
The diagnostic flow chart applying MT, ADA and T-SPOT.TB is an accurate and rapid diagnostic method in detection of TPE.
Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, China. 13789821006@126.com.
Y
Y
He
W
W
Zhang
T
T
Huang
X
X
Wang
M
M
Wang
D000243:Adenosine Deaminase / Q000378:metabolism*; D000328:Adult; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D010996:Pleural Effusion / Q000175:diagnosis*; D012372:ROC Curve; D013906:Thoracoscopy / Q000706:statistics & numerical data*; D014374:Tuberculin Test / Q000706:statistics & numerical data*; D014396:Tuberculosis, Pleural / Q000175:diagnosis*
D000243:Adenosine Deaminase