Sir,
The report on ‘Adenosine Deaminase in Exudative Pleural Effusions’ is very interesting.[1] Mehta et al. have concluded that ‘pleural fluid adenosine deaminase (ADA) is cost-effective and a good screening test for the diagnosis of tuberculosis (TB)’.[1] This conclusion must be carefully considered. First, the reported predictive values of the test, in the present report, are not good.[1] This finding is similar to that of a previous report by Khow-Ean et al.[2] As Islam et al. have noted, the test must be used along with the conventional method to get a diagnosis.[3] Khan et al. have also reported that the use of pleural fluid interferon-gamma can provide a better diagnostic result than ADA.[4] Second, Mehta et al. have not performed any analysis for cost-effectiveness, hence, the conclusion on cost-effectiveness may not be possible. A good report that has considered the cost-effectiveness analysis of using ADA is the previous report by Sharma et al.[5]
REFERENCES
1. Mehta AA, Gupta AS, Ahmed S, Rajesh V. Diagnostic utility of adenosine deaminase in exudative pleural effusions Lung India. 2014;31:142–4
2. Khow-Ean N, Booraphun S, Aekphachaisawat N, Sawanyawisuth K. Adenosine deaminase activity level as a tool for diagnosing tuberculouspleuraleffusion Southeast Asian J Trop Med Public Health. 2013;44:655–9
3. Islam A, Hossain MA, Paul SK, Bhuiyan MR, Khan RA, Rahman MM, et al Role of adenosine deaminase in diagnosis of tubercular pleural effusion Mymensingh Med J. 2014;23:24–7
4. Khan FY, Hamza M, Omran AH, Saleh M, Lingawi M, Alnaqdy A, et al Diagnostic value ofpleuralfluidinterferon-gamma and adenosine deaminase in patients with pleural tuberculosis in Qatar Int J Gen Med. 2013;6:13–8
5. Sharma SK, Banga A. Pleuralfluidinterferon-gamma and adenosine deaminase levels intuberculosis pleural effusion: A cost-effectiveness analysis J Clin Lab Anal. 2005;19:40–6
