Lee Jaehee, Park Ji Eun, Choi Sun Ha, Seo Hyewon, Lee Sang Yub, Lim Jae Kwang, Yoo Seung Soo, Lee Shin Yup, Cha Seung Ick, Park Jae Yong, Kim Chang Ho
Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.
Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Korea.
Korean J Intern Med. 2022 Jan;37(1):137-145. doi: 10.3904/kjim.2020.246. Epub 2021 Jul 15.
BACKGROUND/AIMS: Pleural fluid adenosine deaminase (ADA) levels are useful in discriminating tuberculous pleural effusions (TPEs) from malignant pleural effusions (MPEs). However, some patients with MPE exhibit high-ADA levels, which may mimic TPEs. There is limited data regarding the differential diagnosis between high-ADA MPE and high-ADA TPE. This study aimed to identify the predictors for distinguishing high-ADA MPEs from high-ADA TPEs.
Patients with TPE and MPE with pleural fluid ADA levels ≥ 40 IU/L were included in this study. Clinical, laboratory, and radiological data were compared between the two groups. Independent predictors and their diagnostic performance for high-ADA MPEs were evaluated using multivariate logistic regression analysis and receiver operating characteristic curve.
A total of 200 patients (high-ADA MPE, n = 30, and high-ADA TPE, n = 170) were retrospectively included. In the multivariate analysis, pleural fluid ADA, pleural fluid carcinoembryonic antigen (CEA), and pleural nodularity were independent discriminators between high-ADA MPE and high-ADA TPE groups. Using pleural ADA level of 40 to 56 IU/L (3 points), pleural CEA level ≥ 6 ng/mL (6 points), and presence of pleural nodularity (3 points) for predicting high-ADA MPEs, a sum score ≥ 6 points yielded a sensitivity of 90%, specificity of 96%, positive predictive value of 82%, negative predictive value of 98%, and area under the receiver operating characteristic curve of 0.965.
A scoring system using three parameters may be helpful in guiding the differential diagnosis between high-ADA MPEs and high-ADA TPEs.
背景/目的：胸腔积液腺苷脱氨酶（ADA）水平有助于鉴别结核性胸腔积液（TPE）和恶性胸腔积液（MPE）。然而，一些MPE患者的ADA水平较高，可能会与TPE相似。关于高ADA水平的MPE和高ADA水平的TPE之间的鉴别诊断数据有限。本研究旨在确定区分高ADA水平的MPE和高ADA水平的TPE的预测因素。
本研究纳入了胸腔积液ADA水平≥40 IU/L的TPE和MPE患者。比较两组的临床、实验室和影像学数据。使用多因素逻辑回归分析和受试者工作特征曲线评估高ADA水平MPE的独立预测因素及其诊断性能。
共回顾性纳入200例患者（高ADA水平MPE，n = 30；高ADA水平TPE，n = 170）。在多因素分析中，胸腔积液ADA、胸腔积液癌胚抗原（CEA）和胸膜结节是高ADA水平MPE组和高ADA水平TPE组之间的独立鉴别因素。使用胸腔ADA水平40至56 IU/L（3分）、胸腔CEA水平≥6 ng/mL（6分）和胸膜结节的存在（3分）来预测高ADA水平的MPE，总分≥6分的敏感度为90%，特异度为96%，阳性预测值为82%，阴性预测值为98%，受试者工作特征曲线下面积为0.965。
使用三个参数的评分系统可能有助于指导高ADA水平的MPE和高ADA水平的TPE之间的鉴别诊断。
