Validity of Pleural Fluid Protein in differentiating Tuberculous from Malignant Pleural Effusion

Abstract

Introduction: Tuberculosis (TB) and malignancy are the most common causes of exudative pleural effusion (PE) in our country. Despite the development of new diagnostic methods, closed pleural biopsy and pleural fluid analysis remain the most common ways of establishing diagnosis of tuberculous or malignant PE Objective: Purpose of the study was to determine the validity of pleural fluid protein in differentiating tuberculous from malignant pleural effusion keeping histopathology as gold standard. Methodology: This cross sectional validation study was carried out at department of Pulmonology, Lady Reading hospital Peshawar Pakistan. Those patients fulfilling inclusion criteria were subjected to Abrams needle biopsy and pleural tissue was examined by one histopathologist. In order to know the significant difference of pleural fluid protein level between tuberculous and malignant PE, three categories were made i.e. category-A (3-4 g/dl), Category-B (4-5 g/dl) and Category-C (>5 g/dl). Results: Among total number of 179, males were 114 (63.69%) and females were 65 (36.32%). Age limit was from 15 to 80 years. 60.9% were tuberculous and 39.1% were malignant PE. Among malignant PE the primary were 20 (11.2%) and secondary were 50 (27.9%). Tuberculous PE was more common in younger age group while malignant PE in older age group 88 (49.2%) of the patients were falling in category A, 59 (33%) in category B, and 32 (17.9%) in category C. Conclusion: Plural fluid total protein level is a valuable tool in reaching to the diagnosis of suspected tuberculous or malignant pleural effusion provided it is used in addition to the adequate clinical scenario.