Chest
Volume 131, Issue 4, April 2007, Pages 1133-1141
Journal home page for Chest

Original Research
Pleural Tuberculosis
Diagnostic Value of Interferon-γ in Tuberculous Pleurisy: A Metaanalysis

https://doi.org/10.1378/chest.06-2273Get rights and content

Background

Conventional tests are not always helpful in making a diagnosis of tuberculous pleurisy. Many studies have investigated the usefulness of interferon (IFN)-γ measurements in pleural fluid for the early diagnosis of tuberculous pleurisy. We conducted a metaanalysis to determine the accuracy of IFN-γ measurements in the diagnosis of tuberculous pleurisy.

Methods

After a systematic review of English-language studies, sensitivity, specificity, and other measures of accuracy of IFN-γ concentrations in the diagnosis of pleural effusion were pooled using random-effects models. Summary receiver operating characteristic curves were used to summarize overall test performance.

Results

Twenty-two studies met our inclusion criteria. The summary estimates for IFN-γ in the diagnosis of tuberculous pleurisy in the studies included were as follows: sensitivity, 0.89 (95% confidence interval [CI], 0.87 to 0.91); specificity, 0.97 (95% CI, 0.96 to 0.98); positive likelihood ratio, 23.45 (95% CI, 17.31 to 31.78); negative likelihood ratio, 0.11 (95% CI, 0.07 to 0.16); and diagnostic odds ratio, 272.7 (95% CI, 147.5 to 504.2).

Conclusions

IFN-γ determination is a sensitive and specific test for the diagnosis of tuberculous pleurisy. The measurement of IFN-γ levels in pleural effusions is thus likely to be a useful tool for diagnosing tuberculous pleurisy. The results of IFN-γ assays should be interpreted in parallel with clinical findings and the results of conventional tests.

Section snippets

Search Strategy and Study Selection

Since the present study was a metaanalysis that was based on published articles, we did not include the consents of patients and the approval of internal review boards. We searched the following electronic databases: Medline (1980 to 2006); Embase (1980 to 2006); Web of Science (1990 to 2006); BIOSIS (1993 to 2006); and LILACS (1980 to 2006). We also reviewed the Cochrane Library to find relevant articles. All searches were up to date as of October 2006. The search terms used were

Results

After independent review, 34 publications dealing with pleural IFN-γ concentrations for the diagnosis of TPE were considered to be eligible for inclusion in the analysis.16171819202122232425262728293031323334353637383940414243444546474849 Of these publications, two studies3839 were excluded because IFN-γ concentration was determined only in TPE patients, two studies4041 were excluded because they recruited < 10 patients with confirmed TPE, four studies42434445 were excluded because they did not

Discussion

Making a differential diagnosis between TPE and non-TPE is a critical clinical problem, and the conventional methods, such as the direct examination of pleural fluid by Ziehl-Neelsen staining, culture of the pleural fluid, and pleural biopsy, are not always helpful in making the diagnosis since they have limitations. Findings of microscopy of the pleural fluid is rarely positive (< 5%).505152 Culture of pleural fluid has low sensitivity (24 to 58%), and several weeks are required to grow M

ACKNOWLEDGMENT

We are grateful to the following authors who sent additional information on their primary studies: A. Kaya, C. F. Wong, E. Ribera, K. Ogawa, K. Shimokata, L. Valdés, N. G. Saravia, S. K. Sharma, S. Wongtim, T. Morimoto, T. Pettersson, V. Villena, W. H. Hsu, Y. C. Kim, Y. Aoki, Y. Yamada, and Z. C. Gao.

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    Dr. Shi designed the study, searched the databases, extracted the data, analyzed the results, and wrote the manuscript. Dr. Jiang helped with study design, searching the databases, and writing and revising the manuscript. Dr. Liang formulated the research question, and helped with database searches and analysis. Drs. S.-M. Qin and X.-J. Qin helped to design the data abstraction form and served as second reviewers in extracting the data. All authors read and approved the final manuscript.

    The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

    This study was supported in part by research grant 30660064 from National Natural Science Foundation of China, in part by Program NCET-04–0835 for New Century Excellent Talents in Chinese Universities, and in part by research grant 0639044 from the Natural Science Foundation of Guangxi Zhuang Autonomous Zone, People's Republic of China.

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