Title: Diagnostic utility of pleural fluid ADA and serum CA 125 in exudative pleural effusion and co-relation with histopathology: thoracoscopic pleural biopsy experience at a tertiary care centre in North India
Authors: Dr Dev Singh Jangpangi, Dr Anubhuti Singh, Dr Jagdish Rawat
DOI: https://dx.doi.org/10.18535/jmscr/v6i4.170
Abstract
Pleural effusion is a common respiratory illness. The two most common causes of massive exudative pleural effusion in India are tuberculosis (TB) and malignancy (mainly lung cancer). The confirmatory diagnosis of TB requires the presence of acid fast bacilli or growth of Mycobacterium tuberculosis in pleural fluid culture. Similarly, the conclusive diagnosis of malignancy requires histopathological evidence of cancer in pleural biopsy. Obtaining a thoracoscopic pleural biopsy is not possible or feasible in all patients with massive pleural effusion. Pleural fluid or serum markers can provide diagnostic clues in such patients. We assessed the diagnostic efficacy of pleural fluid ADA and serum CA-125 in 101 patients with massive exudative pleural effusion and compared it with histopathological examination of thoracoscopic pleural biopsy. We found that patients with malignancy were significantly older and had predominantly red coloured pleural fluid. Pleural fluid ADA was significantly higher in tuberculous effusion while serum CA-125 was significantly higher in malignant effusion. The sensitivity of ADA (for a cut off value of 45 U/L) for the diagnosis of TB pleural effusion was 79.6% while sensitivity of serum CA-125 for the cut-off value of 35 U/mL for the diagnosis of malignancy was 80.9%. We concluded that pleural fluid ADA and serum CA-125 can be used as a surrogate markers for tuberculous and malignant pleural effusion respectively.
Keywords: Pleural effusion, ADA, CA 125.
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