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Disorders of the Pleura |

Lymphocytic Pleural Effusion and Change of the Adenosine Deaminase Cut-Off Level in Tuberculosis Diagnosis

Deisy Barrios Barreto, MD; Esteban Perez Rodriguez, PhD; Carolina Gotera, MD; Patricia Lazo Meneses, MD; Paola Arrieta Narvaez, MD; Rosa Mirambeaux Villalona, MD; Salvador Diaz Lobato, PhD; Sagrario Mayoralas Alises, PhD
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Hospital Ramón y Cajal, Madrid, Spain


Chest. 2014;145(3_MeetingAbstracts):274A. doi:10.1378/chest.1821853
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Abstract

SESSION TITLE: Pleural Disease/Pleural Effusion Posters

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: To assess the discriminatory power of pleural ADA levels in pleural effusions lymphomas. - Define the cutoff level in these cases.

METHODS: From 1994 to October 2011, 2413 consecutive pleural effusions (PE) were studied, following the protocol of the pleura unit and were included in our database. All cases were closed with a final diagnosis according to results of pleural fluid, pleural biopsy, treatment response and outcome.Lymphocitic pleural effusions were identified as lymphocyte cell levels equal to or greater than 50% of its cell count, excluding transudates (cardiac, ascites, nephrotic atelectasis, dialysis). Of the 2413 cases, 874 (36.2%) were defined as lymphocytic effusions, of which 118 (13.5%) were TB and 231 (9.57%) are malignant. ADA levels were analyzed by non-parametric tests, expressed as U / l. Statistical analysis was descriptive means, standard deviations, applying Mann-Whitney test, Miettinen and Taylor method.

RESULTS: 985 from 2413 cases (40,85) were lymphocytic pleural effusions. Trasudates 111 (excluded), and exudates 874 (included). From these, 537 (61.4% ) were men and 337 women, with a mean age 64 years ± 17.60. Of the 874 patients, 118 were TB diagnosis (13.5%) with a ADA level of 46.7 ± 15 and 231 (9,57%) malignancy. The mean age in TB group was 21.8 ± 42.5 years (53.8% were younger than 35 years). In ymphocytic pleural effusions, the ADA cutoff levels ≥ 25 U / l, showed a sensitivity of 89.66% and a specificity of 91.01% to identify TB pleural effusions.

CONCLUSIONS: The discriminant cutoff level of ADA in lymphocytic pleural effusions is lower than the overall series (25 UI vs. 35 UI). - High yield was observed in terms of sensitivity and specificity with this ADA cutoff level (25UI).

CLINICAL IMPLICATIONS: Only in countries with a high drugs ressistance, are justified the conventional method with biopsy and culture. -The increase of PPV of ADA in countries with low prevalence of tuberculous is a false argument. The ADA level in malignant pleural effusions is positive false in only 1,5-2,5% of the cases.

DISCLOSURE: The following authors have nothing to disclose: Deisy Barrios Barreto, Esteban Perez Rodriguez, Carolina Gotera, Patricia Lazo Meneses, Paola Arrieta Narvaez, Rosa Mirambeaux Villalona, Salvador Diaz Lobato, Sagrario Mayoralas Alises

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