Combined Use of Pleural Fluid Adenosine Deaminase (ADA), Cytology, Pleural Biopsy and Mantoux test In the Diagnosis of Tuberculous Pleural Effusion

The objective of the present study is to evaluate the use of pleural fluid ADA, cytology, pleural biopsy and Mantoux test in the diagnosis of tuberculous pleural effusion. This prospective study was conducted on 92 patients December 2011– October 2013 at Government Chest Diseases and Tuberculosis Hospital, Hanamkonda. Diagnostic accuracy of pleural fluid cytology (L/N ratio >0.75) , ADA >40 U/L , Pleural biopsy and Mantoux test were 65.22%, 73.91%, 92.13%, 65.22% respectively .Combined pleural fluid ADA , Cytology , pleural biopsy and Mantoux test results were analyzed sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 93.33 %, 93.75%, 96.55%, 88.23% ,93.48 % respectively in the diagnosis of tuberculous effusions among all exudative effusions were better than individual alone. Lymphocyte predominant exudates with high Adenosine deaminase value > 40U/L & caseous granuloma on pleural biopsy are highly suggestive of Tubercular pleurisy. Combined use of ADA, Cytology, Pleural biopsy and Mantoux test are more helpful in diagnosing Tubercular pleural effusions rather than individual alone.