Diagnostic accuracy of tumor necrosis factor-alpha, interferon-gamma, interlukine-10 and adenosine deaminase 2 in differential diagnosis between tuberculous pleural effusion and malignant pleural effusion

Background: The current study was performed to investigate the potential biomarkers for the differential diagnosis of tuberculous pleural effusion (TPE) and malignant pleural effusions (MPE). Methods: Among ninety patients (n = 90) involved in the study, 47 with tuberculous pleural effusion aged from 18 to 70 and 43 with secondary malignant pleural effusion aged from 34 to 78. We tested the pleural levels of TNF-alpha, IFN-gamma and IL-10 as well as the enzyme activity of ADA(2), and then we compared the differential diagnostic efficiencies of those biochemical parameters with ADA between the two groups. Results: Our results show that, the concentrations of pleural TNF-alpha (45.55 +/- 15.85 ng/L), IFN-gamma (114.97 +/- 27.85 ng/L) as well as activities of ADA(2) (35.71 +/- 10.00 U/L) and ADA (39.39 +/- 10.60 U/L) in tuberculous group were significantly higher compared to malignant group. Furthermore, according to the ROC curve analysis the thresholds of TNF-alpha, IFN-gamma, ADA(2) and ADA were found to be 30.3 ng/L, 103.65 ng/L, 29.45 U/L, and 39.00 U/L, respectively. TNF-alpha, IFN-gamma and ADA(2) yielded better sensitivity, specificity, and accuracy of the diagnosis than ADA. Our investigation further revealed that the combinations of TNF-alpha and ADA(2) further increased the specificity and accuracy for the differential diagnosis. Conclusion: In conclusion, we found that TNF-alpha, IFN-gamma, ADA and ADA(2) all increased in TPE. Combinations of the TNF-alpha and ADA(2) yielded the best specificity and accuracy for the differential diagnosis of TPE from MPE. Our investigation suggests that the applications of TNF-alpha together with ADA(2) may contribute to more efficient diagnosis strategies in the management of discrimination between tuberculous and malignant pleural effusions.