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Observational Study
. 2016:2016:7348239.
doi: 10.1155/2016/7348239. Epub 2016 Dec 14.

Differentiating Malignant from Tubercular Pleural Effusion by Cancer Ratio Plus (Cancer Ratio: Pleural Lymphocyte Count)

Akash Verma  1 , Rucha S Dagaonkar  1 , Dominic Marshall  2 , John Abisheganaden  1 , R W Light  3
Affiliations
Observational Study

Differentiating Malignant from Tubercular Pleural Effusion by Cancer Ratio Plus (Cancer Ratio: Pleural Lymphocyte Count)

Akash Verma et al. Can Respir J. 2016.

Abstract

Background. We performed prospective validation of the cancer ratio (serum LDH : pleural ADA ratio), previously reported as predictive of malignant effusion retrospectively, and assessed the effect of combining it with "pleural lymphocyte count" in diagnosing malignant pleural effusion (MPE). Methods. Prospective cohort study of patients hospitalized with lymphocyte predominant exudative pleural effusion in 2015. Results. 118 patients, 84 (71.2%) having MPE and 34 (28.8%) having tuberculous pleural effusion (TPE), were analysed. In multivariate logistic regression analysis, cancer ratio, serum LDH : pleural fluid lymphocyte count ratio, and "cancer ratio plus" (ratio of cancer ratio and pleural fluid lymphocyte count) correlated positively with MPE. The sensitivity and specificity of cancer ratio, ratio of serum LDH : pleural fluid lymphocyte count, and "cancer ratio plus" were 0.95 (95% CI 0.87-0.98) and 0.85 (95% CI 0.68-0.94), 0.63 (95% CI 0.51-0.73) and 0.85 (95% CI 0.68-0.94), and 97.6 (95% CI 0.90-0.99) and 94.1 (95% CI 0.78-0.98) at the cut-off level of >20, >800, and >30, respectively. Conclusion. Without incurring any additional cost, or requiring additional test, effort, or time, cancer ratio maintained and "cancer ratio plus" improved the specificity of cancer ratio in identifying MPE in the prospective cohort.

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Conflict of interest statement

Akash Verma, Rucha S. Dagaonkar, Dominic Marshall, John Abisheganaden, and R. W. Light have no potential competing interests to report.

Figures

Figure 1
Figure 1
(a) ROC curve for various cut-off levels of cancer ratio in differentiating between malignant pleural effusions from TB pleural effusion. AUC of 0.81 suggests good accuracy of this test. (b) ROC curve for various cut-off levels of cancer ratio plus (cancer ratio: pleural fluid lymphocyte count) in differentiating between malignant pleural effusion from TB pleural effusion. AUC of 0.86 suggests good accuracy of this test. (c) ROC curve for various cut-off levels of serum LDH : pleural lymphocyte count ratio in differentiating between malignant pleural effusion from TB pleural effusion. AUC of 0.68 suggests poor accuracy of this test.
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