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Diagnostic utility of QuantiFERON-TB Gold and Xpert MTB/RIF combined with adenosine deaminase in tuberculous pleural effusion: a prospective study

Egyptian Journal of Bronchology volume 11, pages 346–354 (2017)Cite this article

Abstract

Objective

Tuberculous pleural effusion remains difficult to diagnose despite numerous diagnostic tools. The aim of this study was to evaluate and compare the diagnostic efficiency of adenosine deaminase (ADA) analysis in the diagnosis of tuberculous pleural effusion when used alone or in combination with QuantiFERON-TB Gold (QFT-G) or Xpert MTB/RIF.

Patients and methods

Seventy-one patients with unknown bilateral or unilateral pleural effusion were subjected to pleural tapping, and pleural fluid samples were subjected to total ADA, QFT-G, and Xpert MTB/RIF. Pleural biopsies (thoracoscopic or closed) were performed for 41 patients, sent for histopathology of tuberculosis culture and Xpert MTB/ RIF, and they were differentiated into tuberculous (TB) and non-TB effusions by culture for Myobacterium tuberculosis and/or histopathology of pleural biopsy.

ADA results were further analyzed using receiver operating characteristic curve to determine the cutoff values to achieve the optimum sensitivity and specificity.

Results

Forty-six patients had definite TB pleural effusion and 25 patients had non-TB pleural effusion. For ADA at a cutoff point of >40 IU/l, the sensitivity was 97.83% (n=45) [95% confidence interval (CI): 88.47–99.94%) and specificity was 76.00% (95% CI: 54.87–90.64%), but at a cutoff point of 70 U/l, the specificity was 96.00% (95% CI: 79.65–99.90%) and sensitivity was 84.78% (n=39) (95% CI: 71.13–93.66%). The sensitivity of QFT-G was 23.91% (95% CI: 12.59–38.77%) and specificity was 96.00% (95% CI: 79.65–99.90%). The sensitivity of Xpert MTB/RIF was 47.83% (95% CI: of 32.89–63.05%) and specificity was 100.00% (95% CI: 86.28–100.00%). Combined analysis of ADA at a cutoff value greater than 70 U/l with Xpert MTB/RIF showed a sensitivity of 85.64% (95% CI: 71.13–96.23%) and specificity of 98.50% (95% CI: 78.64–99.93%). ADA at a lower cutoff value greater than 40 U/l showed a sensitivity of 96.78% (95% CI: 77.13–99.66%) and specificity of 97.00% (95% CI: 79.65–99.90%).

Conclusion

ADA is a useful marker in the diagnosis of TB pleural effusion. ADA specificity with low cutoff value can be improved by combining with Xpert MTB/RIF, resulting in an accurate test to identify patients with suspected TB pleural effusion.

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Authors and Affiliations

  1. Chest Diseases Department, Kasr El-Aini Hospital, Faculty of Medicine, Cairo University, 44 Dokki Street, Giza, 11956, Egypt

    Hassan Aref MD

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  1. Hassan Aref MD
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Correspondence to Hassan Aref MD.

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Aref, H. Diagnostic utility of QuantiFERON-TB Gold and Xpert MTB/RIF combined with adenosine deaminase in tuberculous pleural effusion: a prospective study. Egypt J Bronchol 11, 346–354 (2017). https://doi.org/10.4103/ejb.ejb_29_17

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