Source: Annual Congress 2010 - Novel approach in diagnosis and treatment of pleural effusions
Disease area: Respiratory infections, Thoracic oncology

Abstract

T-cell interferon gamma release assays (IGRAs) are now widely available and used in tuberculosis contact screening and the diagnosis of latent TB. However, their clinical utility in the investigation of undiagnosed lymphocytic effusions is not established. Aims: To prospectively evaluate the diagnostic accuracy of IGRA in patients presenting with a cytology negative lymphocytic or mixed lymphocytic undiagnosed pleural effusion.
Methods: Consecutive in and outpatients presenting to the respiratory department of a large UK teaching hospital over an 18 month period were included. A commercially available IGRA, T-SPOT TB (Oxford Immunotec, Abingdon, UK) was used and patient serum tested and compared to the ultimate diagnosis. Patients were followed up for 12 months or death.
Results: 49 patients were included – median age of 77 years (range 32-98), male 31, female 18, 45 caucasian. Right sided effusion 26, left 17 and bilateral 6.The ultimate cause of pleural effusion was cardiac 12/49 (24%), lymphoma 5/49 (10%), inflammatory pleuritis 7/49 (14%), mesothelioma 5/49 (10%), malignancy 5/49 (10%), TB pleurits 5/49 (10%), pleural infection 4/49 (8%) and other benign cause 4/49 (8%) and unknown 2/49. Of the 5 cases of proven TB pleurits T-spot was positive in 4. The false negative occurred in a lady with immunosuppression due to myeloma. In addition 5 patients without active TB had a positive test. 37 patients without TB all had a negative T-spot. Sensitivity 80%, specificity 88% , PPV 44%, NPV 97%.
Conclusion: In immunocompetent individuals T-spot has a high NPV and is useful in excluding TB pleuritis in lymphocytic undiagnosed effusions.

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Citations should be made in the following way:
H. Lamb, C. Hooper, P. Virgo, N. Noel, A. Kavidasan, M. Gompels, N. Maskell (Bristol, United Kingdom). A prospective observational trial examining the value of T-cell interferon gamma release assays (IGRAs) in undiagnosed lymphocytic pleural effusions. Eur Respir J 2010; 36: Suppl. 54, 226

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