The report on ‘Adenosine Deaminase in Exudative Pleural Effusions’ is very interesting. 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)’. This conclusion must be carefully considered. First, the reported predictive values of the test, in the present report, are not good. This finding is similar to that of a previous report by Khow-Ean et al. As Islam et al. have noted, the test must be used along with the conventional method to get a diagnosis. Khan et al. have also reported that the use of pleural fluid interferon-gamma can provide a better diagnostic result than ADA. 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.
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