title: Differentiating Malignant from Tubercular Pleural Effusion by Cancer Ratio Plus (Cancer Ratio: Pleural Lymphocyte Count).
abstract: Background. We performed prospective validation of the cancer ratio (serum LDH : pleural ADA ratio), previously reported as predictive of malignant effusion retrospectively, and assessed the effect of combining it with "pleural lymphocyte count" in diagnosing malignant pleural effusion (MPE).Methods. Prospective cohort study of patients hospitalized with lymphocyte predominant exudative pleural effusion in 2015.Results. 118 patients, 84 (71.2%) having MPE and 34 (28.8%) having tuberculous pleural effusion (TPE), were analysed. In multivariate logistic regression analysis, cancer ratio, serum LDH : pleural fluid lymphocyte count ratio, and "cancer ratio plus" (ratio of cancer ratio and pleural fluid lymphocyte count) correlated positively with MPE. The sensitivity and specificity of cancer ratio, ratio of serum LDH : pleural fluid lymphocyte count, and "cancer ratio plus" were 0.95 (95% CI 0.87-0.98) and 0.85 (95% CI 0.68-0.94), 0.63 (95% CI 0.51-0.73) and 0.85 (95% CI 0.68-0.94), and 97.6 (95% CI 0.90-0.99) and 94.1 (95% CI 0.78-0.98) at the cut-off level of >20, >800, and >30, respectively.Conclusion. Without incurring any additional cost, or requiring additional test, effort, or time, cancer ratio maintained and "cancer ratio plus" improved the specificity of cancer ratio in identifying MPE in the prospective cohort.
authors.affiliation: Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore 308433.
authors.forename: Akash
authors.identifier: 0000-0002-7000-8708
authors.initials: A
authors.lastname: Verma
authors.affiliation: Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore 308433.
authors.forename: Rucha S
authors.initials: RS
authors.lastname: Dagaonkar
authors.affiliation: Department of Medicine, Imperial College London, London SW7 2AZ, UK.
authors.forename: Dominic
authors.initials: D
authors.lastname: Marshall
authors.affiliation: Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore 308433.
authors.forename: John
authors.initials: J
authors.lastname: Abisheganaden
authors.affiliation: Pulmonary Disease Program, Vanderbilt University, 1161 21st Ave. South, Nashville, TN 37232, USA.
authors.forename: R W
authors.initials: RW
authors.lastname: Light
mesh_terms: D000243:Adenosine Deaminase / Q000378:metabolism*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005122:Exudates and Transudates / Q000166:cytology / Q000378:metabolism*; D005260:Female; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000378:metabolism*; D008175:Lung Neoplasms / Q000150:complications*; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D016066:Pleural Effusion, Malignant / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014397:Tuberculosis, Pulmonary / Q000150:complications*; D055815:Young Adult
chemical_list: D007770:L-Lactate Dehydrogenase; D000243:Adenosine Deaminase