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A meta-analysis of Indian studies assessed the diagnostic performance of pleural-fluid adenosine deaminase for tuberculous pleural effusion. Across more than 40 studies and several thousand patients, pooled sensitivity and specificity were high, supporting ADA as a useful component of diagnostic evaluation in TB-endemic practice. The clinically important point is that ADA should be interpreted in context rather than used as an isolated rule-in or rule-out test. Age, local TB prevalence, pleural-cell profile, clinical presentation, and alternative diagnoses all affect how a result should be understood. The evidence is especially relevant in India, where tuberculous pleuritis is common but malignant and other inflammatory causes of exudative effusion also need consideration. For HCPs, the paper offers a practical framework: use pleural fluid analysis to establish an evidence-based pretest probability, then escalate to tissue diagnosis when the clinical picture and fluid results do not agree. This matches the conference’s emphasis on a “beyond Light’s criteria” approach and on knowing when to move from fluid biomarkers to medical thoracoscopy.
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A meta-analysis of Indian studies assessed the diagnostic performance of pleural-fluid adenosine deaminase for tuberculous pleural effusion. Across more than 40 studies and several thousand patients, pooled sensitivity and specificity were high, supporting ADA as a useful component of diagnostic evaluation in TB-endemic practice. The clinically important point is that ADA should be interpreted in context rather than used as an isolated rule-in or rule-out test. Age, local TB prevalence, pleural-cell profile, clinical presentation, and alternative diagnoses all affect how a result should be understood. The evidence is especially relevant in India, where tuberculous pleuritis is common but malignant and other inflammatory causes of exudative effusion also need consideration. For HCPs, the paper offers a practical framework: use pleural fluid analysis to establish an evidence-based pretest probability, then escalate to tissue diagnosis when the clinical picture and fluid results do not agree. This matches the conference’s emphasis on a “beyond Light’s criteria” approach and on knowing when to move from fluid biomarkers to medical thoracoscopy.
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