Is Adenosine Deaminase in Pleural Fluid a Useful Marker for Differentiating Tuberculosis from Lung Cancer or Mesothelioma in Japan, a Country with Intermediate Incidence of Tuberculosis?
Department of Respiratory Medicine, NHO Yamaguchi-Ube Medical Center, Ube, Japan. Acta medica Okayama
(Impact Factor: 0.7).
The objective of this study was to evaluate the utility of the determination of adenosine deaminase (ADA) level in pleural fluid for the differential diagnosis between tuberculous pleural effusion (TPE) and malignant pleural effusion (MPE) in Japan, a country with intermediate incidence of tuberculosis (TB). We retrospectively reviewed the clinical records of 435 patients with pleural effusion and investigated their pleural ADA levels as determined by an auto analyzer. ROC analysis was also performed. The study included patients with MPE (n＝188), TPE (n＝124), benign nontuberculous pleural effusion (n＝94), and pleural effusion of unknown etiology (n＝29). The median ADA level in the TPE group was 70.8U/L, which was significantly higher than that in any other groups (p＜0.05). The area under the curve (AUC) in ROC analysis was 0.895. With a cut-off level for ADA of 36U/L, the sensitivity, specificity, positive predictive value, and negative predictive value were 85.5%, 86.5%, 69.7%, and 93.6%, respectively. As many as 9% of patients with lung cancer and 15% of those with mesothelioma were false-positive with this ADA cutoff setting. Although the ADA activity in pleural fluid can help in the diagnosis of TPE, it should be noted that some cases of lung cancer or mesothelioma show high ADA activity in geographical regions with intermediate incidence of TB, in contrast to high prevalence areas.
Available from: Nenad Joksimovic
- "However, elevated ADA in ascites has rarely been reported in the diagnosis of lymphoma . False negative and false positive ADA values are possible, and therefore an elevated ADA in ascites should be interpreted in relation to the overall clinical presentation and should not be considered equivalent to the presence of mycobacteria [52, 54]. "
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ABSTRACT: The gastrointestinal tract is the most common extranodal site involved with lymphoma accounting for 5-20% of all cases. Lymphoma can occur at any site of the body, but diffuse and extensive involvement of the peritoneal cavity is unusual and rare. We report a case of diffuse large B-cell lymphoma in a 57-year-old female infiltrating the peritoneum and omentum and presenting with ascites and pleural effusion. The performed examinations did not discover any pathological findings affecting the digestive tract or parenchymal organs, except for diffuse thickening of the peritoneum and omentum. Peripheral, mediastinal, or retroperitoneal lymphadenopathy was not registered. The blood count revealed only elevated leukocytes and on examination there were no immature blood cells in the peripheral blood. The cytology from the ascites and pleural effusion did not detect any malignant cells. Due to the rapid disease progression the patient died after twenty-two days of admission. The diagnosis was discovered postmortem with the histological examination and immunohistochemical study of the material taken during the surgical laparoscopy performed four days before the lethal outcome. Although cytology is diagnostic in most cases, laparoscopy with peritoneal biopsy is the only procedure which can establish the definitive diagnosis of peritoneal lymphomatosis.
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ABSTRACT: The critical spare parts (CSP) are vital to machine operation, which also have the characteristic of more expensive, larger demand variation, longer purchasing lead time than non-critical spare parts. Therefore, it is an urgent issue to devise a way to forecast the future required amount of CSP accurately.This investigation proposed moving back-propagation neural network (MBPN) and moving fuzzy neuron network (MFNN) to effectively predict the CSP requirement so as to provide as a reference of spare parts control. This investigation also compare prediction accuracy with other forecasting methods, such like grey prediction method, back-propagation neural network (BPN), fuzzy neuron network (FNN), etc. All of the prediction methods evaluated the real data, which are provided by famous wafer testing factories in Taiwan, the effectiveness of the proposed methods is demonstrated through a real case study.
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ABSTRACT: Tuberculosis, caused by Mycobacterium tuberculosis, is the commonest health problem worldwide. It is conclusively diagnosed on the basis of the presence of Mycobacterium in body fluids. Routine investigations for the detection of the disease are many times falsely negative or positive as Mycobacterium is not easily detectable. Newer investigations have shown adenosine deaminase enzyme (ADA), a new marker for the disease. Current study was aimed to confirm the correlation between increased ADA levels in pleural fluid of patients who have been diagnosed with tuberculosis. The study was conducted at Narinder Mohan Hospital and Research Centre, Ghaziabad, India. Eighty three patients (57 males and 26 females, from age group 15-78 years) were screened for pleural effusion, out of which 67 were tuberculous and 16 non-tuberculous. The ADA levels of these samples were measured along with ELISA, culture and other routine investigations. In all 67 patients belonging to tuberculous group, the ADA levels were above 40U/L with a mean value of 115.71±35.00, whereas in non-tuberculous group only two cases were above 40U/L with a mean value of 26.73±10.11. Reference values used for ADA levels in pleural fluid were - Normal: <40U/L; Suspect: 40-60 U/L and Positive: >60 U/L. The test was found to be significantly specific and sensitive even at higher cut off value. Raised levels of ADA in the pleural fluid are a suggestive marker for Mycobacterium presence in pleural effusion.
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