Adenosine Deaminase in Pleural Effusion and Its Relationship with Clinical Parameters in Patients with Malignant Pleural Mesothelioma

Our plain-English summary of Adenosine Deaminase in Pleural Effusion and Its Relationship with Clinical Parameters in Patients with Malignant Pleural Mesothelioma, by Y. Nakajima, K. Kuribayashi, H. Ishigaki, et al (Cancer Investigation, 2020).

The study

• Authors: Y. Nakajima, K. Kuribayashi, H. Ishigaki, A. Tada, Y. Negi, T. Minami, R. Takahashi, H. Doi, K. Kitajima, T. Yokoi, T. Kijima
• Journal: Cancer Investigation
• Published: 2020;38(6):356-364
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Pleural effusion adenosine deaminase (ADA) levels are elevated in various diseases. We investigated whether pleural effusion ADA levels differ among patients with malignant pleural mesothelioma (MPM), lung cancer (LC), and benign diseases, including tuberculous pleurisy. We examined 329 patients from February 2002 to July 2013. There were 131 MPM cases with ADA levels of 32.29 IU/L; 117 LC cases with ADA levels of 21.12 IU/L; 54 benign disease cases with ADA levels of 20.98 IU/L. A significant difference existed in pleural effusion ADA levels between MPM and benign disease patients. Pleural effusion ADA levels were significantly higher in MPM patients.

In plain English

This retrospective study from Hyogo College of Medicine, Japan, measured the enzyme adenosine deaminase (ADA) in pleural effusion (fluid around the lungs) from 329 patients treated February 2002 to July 2013. Asbestos exposure was not studied. Average ADA was 32.29 IU/L in 131 patients with malignant pleural mesothelioma, 21.12 in 117 with lung cancer, 20.78 in 54 with benign disorders other than tuberculous pleurisy, 17.92 in 20 with other cancers, and 79.43 in 7 with tuberculous pleurisy. Mesothelioma levels differed significantly from other diseases. With a 22.60 IU/L cut-off, ADA separated mesothelioma from lung cancer with 63.4% sensitivity and 73.6% specificity; with a 67.20 IU/L cut-off, it separated mesothelioma from tuberculous pleurisy with 96.9% sensitivity and 71.4% specificity. Within mesothelioma, ADA did not differ significantly by tissue type or between T4 and other T stages. Survival did not differ significantly between patients above 40 IU/L and those at or below it. Of 38 mesothelioma patients at 40 IU/L or higher, 3 had been treated for tuberculous pleurisy. The authors concluded that high ADA levels may mask undiagnosed malignant pleural effusion.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective study of medical records, comparing pleural effusion ADA levels across disease groups, with ROC curve analysis and survival (Kaplan–Meier) analysis
• Who was studied: 329 patients with pleural effusion sampled for diagnosis, treated at the Division of Respiratory Medicine, Hyogo College of Medicine, Japan, February 2002 to July 2013. The patients were 131 with malignant pleural mesothelioma (MPM), 117 with lung cancer, 54 with benign disorders other than tuberculous pleurisy, 20 with other malignant disorders, and 7 with tuberculous pleurisy.
• Exposure: No asbestos exposure was studied. The measure studied was pleural effusion ADA level, taken from medical records and measured by latex agglutination turbidimetry.
• Main results:
  • Mean pleural effusion ADA levels by group: MPM 32.29 IU/L, lung cancer 21.12 IU/L, benign disorders (other than tuberculous pleurisy) 20.78 IU/L.
  • Median ADA in MPM was 26.50 IU/L, which differed significantly from the other diseases (P less than 0.001).
  • Distinguishing MPM from lung cancer: area under the curve 0.7232, at an optimal cut-off of 22.60 IU/L. Sensitivity for MPM was 63.4% and specificity 73.6%.
  • Distinguishing MPM from tuberculous pleurisy: area under the curve 0.8800, at a cut-off of 67.20 IU/L. Sensitivity for diagnosing MPM was 96.9% and specificity 71.4%.
  • Among MPM patients, ADA levels did not differ significantly between the epithelial type and other tissue types, or between T4 and other T factors.
  • 38 (29.0%) of the 131 MPM patients had a pleural effusion ADA level of 40 IU/L or higher.
  • Of these 38 MPM patients with high ADA, 3 (8%) had been diagnosed with tuberculous pleurisy and previously prescribed an anti-tuberculosis drug.
  • Median overall survival in MPM did not differ significantly between patients with ADA above 40 IU/L and those at or below 40 IU/L (P greater than 0.05).
• The authors' conclusion: The authors concluded that high pleural effusion ADA levels may mask the presence of undiagnosed malignant pleural effusion. They also concluded that in such patients tuberculous pleurisy must be distinguished from malignant effusion, with thoracoscopic investigation done proactively.
• Limitations the authors state:
  • The authors state that the value of testing ADA in pleural effusion is limited by the difficulty of identifying its isozymes.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Effusion, Pleural Mesothelioma, Lung Cancer, Tuberculous pleurisy.

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• Predicting Malignant and Paramalignant Pleural Effusions by Combining Clinical, Radiological and Pleural Fluid Analytical Parameters — S. Herrera Lara, E. Fernández-Fabrellas, et al. (2017)
• Tumor-associated macrophage-derived inflammatory cytokine enhances malignant potential of malignant pleural mesothelioma — D. Horio, T. Minami, et al. (2020)
• Early-stage Clinical Characterization of Malignant Pleural Mesothelioma — Y. Negi, K. Kuribayashi, et al. (2018)
• Prognostic value of pretreatment volume-based quantitative 18F-FDG PET/CT parameters in patients with malignant pleural mesothelioma — K. Kitajima, H. Doi, et al. (2017)
• Investigating unilateral pleural effusions: the role of cytology — D.T. Arnold, D. De Fonseka, et al. (2018)

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