ArticleJournal of Korean medical science2025
Tuberculous and Malignant Pleural Effusions With Adenosine Deaminase Levels of 40-70 IU/L: Trends in New Cases Over Time and Differentiation Between Groups.
Article in Journal of Korean medical science, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Diagnostic value of biochemical ratios in the differential diagnosis of tuberculous and malignant pleural effusions.BMC pulmonary medicine · 2026Article
- Development and validation of a diagnostic model for malignant pleural effusion based on random forest.Journal of thoracic disease · 2026Article
- The cancer ratio plus in the differential diagnosis of pleural effusions: a scoping review of current evidence.Biochemia medica · 2026Article
- Diagnostic performance of adenosine deaminase activity in pleural fluid in tuberculous pleural effusion and relevant factors: a single-center experience with 1,491 consecutive patients.BMC pulmonary medicine · 2025Article
- Diagnostic Utility of Thoracoscopy in Recurrent Exudative Pleural Effusion: A Single-Arm Interventional Study.Cureus · 2025Article
- Diagnostic utility of ADA and CBNAAT in tubercular pleural effusion.Bioinformation · 2025Article
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Abstract
backgroundThe diagnosis of tuberculous pleural effusion (TPE) often relies on pleural fluid adenosine deaminase (ADA) levels. The diagnostic utility of ADA, however, is influenced by the prevalence of tuberculosis (TB) in local populations. Malignant pleural effusion (MPE) cases can exhibit moderately elevated ADA levels comparable to those seen in TPE. As population aging potentially impacts ADA levels, global TB incidence is decreasing whereas the burden of malignancy is on the rise. Consequently, epidemiological shifts and temporal changes in ADA distribution complicate the differential diagnosis between TPE and MPE when ADA levels are within the 40-70 IU/L range. Nonetheless, data specific to this subset are scarce.
methodsThis retrospective study included consecutive patients aged > 18 years with confirmed TPE and MPE, spanning from 2012 to 2023. ADA levels in pleural fluid were categorized into three groups: < 40 IU/L, 40-70 IU/L, and > 70 IU/L. The study examined annual trends in the frequency of new cases and ADA level distributions over time and identified discriminating factors between TPE and MPE in cases with ADA levels of 40-70 IU/L.
resultsIn total, 297 TPE and 369 MPE cases were included in this study. Over the study period, the frequency of TPE progressively declined, while that of MPE increased. In the most recent four-year period, new TPE and MPE cases with ADA levels of 40-70 IU/L occurred at comparable numbers. Multivariable analysis identified pleural fluid carcinoembryonic antigen (CEA) levels and the number of focal pleural nodules as independent predictors for MPE. Specifically, the presence of either CEA levels > 15.7 ng/mL or more than eight pleural nodules yielded the highest diagnostic accuracy with a sensitivity of 88%, specificity of 100%, and an area under the curve of 0.95.
conclusionThe differential diagnosis between TPE and MPE with pleural ADA levels of 40-70 IU/L has become increasingly critical due to evolving epidemiological patterns and ADA distribution changes over time. Pleural fluid CEA levels and the characteristics of pleural nodules may offer valuable guidance in distinguishing between TPE and MPE within this diagnostic gray zone.
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