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Tuberculosis & Respiratory Diseases

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Vol.59 No.6
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TNF-α in the Pleural Fluid for the Differential Diagnosis of Tuberculous and Malignant Effusion

Tuberculosis & Respiratory Diseases / Tuberculosis & Respiratory Diseases,
2005, v.59 no.6, pp.625-630







& (2005). TNF-α in the Pleural Fluid for the Differential Diagnosis of Tuberculous and Malignant Effusion. Tuberculosis & Respiratory Diseases, 59(6), 625-630.
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Abstract

Background : Determining the cause of an exudative pleural effusion is sometimes quite difficult, especially between malignant and tuberculous  effusions. Twenty percent of effusions remain undiagnosed even after a complete diagnostic evaluation, including pleural biopsy. The activity of tumor necrosis factor-alpha (TNF-α), which is the one of  proinflammatory cytokines, is increased in both infectious and malignant effusions. The aim of this study was to investigate the diagnostic efficiency of TNF-α activity in distinguishing tuberculous from malignant effusions. Methods : 46 patients (13 with malignant pleural effusion, 33 with tuberculous pleural effusion) with exudative pleurisy were included. TNF-α concentrations were measured in the pleural fluid and serum samples using an enzyme- linked immunosorbent assay (ELISA). In addition, TNF-α ratio (pleural fluid TNF-α : serum TNF-α) was calculated. Results : TNF-α concentration and TNF-α ratio in the pleural fluid were significantly higher in the tuberculous effusions than in the malignant effusions (p＜0.05). However, the serum levels of TNF-α in the malignant and tuberculous pleural effusions were similar (p＞0.05). The cut off points for the pleural fluid TNF-α level and TNF-α ratio were found to be 136.4 pg/mL and 6.4, respectively. The sensitivity, specificity and area under the curve were 81%, 80% and 0.82 for the pleural fluid TNF-α level (p＜0.005) and 76%, 70% and 0.72 for the TNF-α ratio (p＜0.05). Conclusion : We conclude that pleural fluid TNF-α level and TNF-α ratio can distinguish a malignant pleural effusion from a tuberculous effusion, and can be additional markers in a differential diagnosis of tuberculous and malignant pleural effusion. The level of TNF-α in the pleural fluid could be a more efficient marker than the TNF-α ratio. (Tuberc Respir Dis 2005; 59: 625-630)

keywords
Pleural effusion, Malignancy, Tuberculosis, Tumor factor, Pleural effusion, Malignancy, Tuberculosis, Tumor factor

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