|LETTER TO EDITOR
|Year : 2014 | Volume
| Issue : 4 | Page : 434
Asmita Anilkumar Mehta, Amit Satish Gupta, Subin Ahmed, Rajesh Venkitakrishnan
Department of Pulmonary Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
|Date of Web Publication||1-Oct-2014|
Asmita Anilkumar Mehta
Department of Pulmonary Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mehta AA, Gupta AS, Ahmed S, Venkitakrishnan R. Author's reply. Lung India 2014;31:434
We would like to thank Wiwanitkit et al., for their interest in our study and their valuable observations.
In response to the authors' comments about the reported lower predictive value of the adenosine deaminase (ADA) test in our article,  we want to clarify that as per our study, ADA is a valuable test to differentiate malignancy from TB. Our study showed that only three (8%) out of 36 cases of malignant pleural effusion had ADA ≥40 U/l.
We agree with the authors' comments that ADA must be used along with the conventional method to get a diagnosis, as suggested by Islam et al. 
Khan et al.  has showed that use of the pleural fluid interferon-gamma can provide a better diagnostic result than ADA, but at a higher cost.  We would also like to quote from the meta-analysis by Greco et al., which showed that the joint sensitivity and specificity of ADA (93%) was similar to IFN-γ (96%) and no significant difference was present in the performance of both the tests in the diagnosis of TB pleurisy. 
We accept that we have not conducted a cost-effectiveness analysis for our study,  and it is improper to state in conclusion that the ADA test is cost-effective. Despite what has just been stated, it has been seen that the ADA test is less expensive than other invasive tests like the thoracoscopy-guided or blind pleural biopsy.
| References|| |
|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.||Islam A, Hossain MA, Paul SK, Bhuiyan MR, Khan RA, Rahman MM, et al. Role of adenosine deaminase in diagnosis of tubercularpleuraleffusion.Mymensingh Med J 2014;23:24-7. |
|3.||Khan FY, Hamza M, Omran AH, Saleh M, Lingawi M, Alnaqdy A, et al. Diagnostic value of pleural fluid interferon-gamma and adenosinedeaminase in patients with pleural tuberculosis in Qatar. Int J Gen Med 2013;6:13-8. |
|4.||Greco S, Girardi E, Masciangelo R, Capoccetta GB, Saltini C. Adenosine deaminase and interferon gamma measurements for the diagnosis of tuberculous pleurisy: A meta-analysis. Int J Tuberc Lung Dis 2003;7:777-86. |