title: A combination of the QuantiFERON-TB Gold In-Tube assay and the detection of adenosine deaminase improves the diagnosis of tuberculous pleural effusion.
abstract: 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.
authors.affiliation: Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai 200040, China.
authors.forename: Yuanyuan
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Pulmonary Diseases, Wuxi No. 5 People's Hospital, Wuxi 214005, Jiangsu Province, China.
authors.forename: Qinfang
authors.initials: Q
authors.lastname: Ou
authors.affiliation: Department of Pulmonary Diseases, Wuxi No. 5 People's Hospital, Wuxi 214005, Jiangsu Province, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Zheng
authors.affiliation: Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai 200040, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Shen
authors.affiliation: Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai 200040, China.
authors.forename: Bingyan
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai 200040, China.
authors.forename: Xinhua
authors.initials: X
authors.lastname: Weng
authors.affiliation: Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai 200040, China.
authors.forename: Lingyun
authors.initials: L
authors.lastname: Shao
authors.affiliation: Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai 200040, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Gao
authors.affiliation: Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai 200040, China.|Key Laboratory of Medical Molecular Virology, Ministry of Education and Health, Shanghai Medical College, Fudan University, Shanghai 200032, China.
authors.forename: Wenhong
authors.initials: W
authors.lastname: Zhang
mesh_terms: D000243:Adenosine Deaminase / Q000032:analysis*; D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007371:Interferon-gamma / Q000097:blood* / Q000276:immunology; D059425:Interferon-gamma Release Tests; D008297:Male; D010996:Pleural Effusion / Q000201:enzymology* / Q000276:immunology; D016066:Pleural Effusion, Malignant / Q000175:diagnosis* / Q000276:immunology; D011933:Reagent Kits, Diagnostic; D012680:Sensitivity and Specificity; D014396:Tuberculosis, Pleural / Q000175:diagnosis* / Q000276:immunology / Q000382:microbiology; D055815:Young Adult
chemical_list: D015415:Biomarkers; D011933:Reagent Kits, Diagnostic; D007371:Interferon-gamma; D000243:Adenosine Deaminase