Prospective studies that assessed ADA activity in PE in patients with TP, and that provided sufficient data to calculate the sensitivity and specificity, were eligible for inclusion. The method used to determine ADA activity had to be the same in all studies (it is unclear whether the methodology was specified a priori) and studies had to report data at a threshold of 40 U/L to define a positive ADA result. All studies used the Giusti methodology to measure ADA.
Inclusion criteria were not defined in terms of the reference standard. Diagnostic criteria for TP included Mycobacterium tuberculosis positive in PE or tissue culture, histopathological examination of pericardial with granulomas containing alcohol-acid resistant bacilli granulomas in pericardial tissue associated with active tuberculosis in another site, and clinical and/or laboratory evidence of TP that had clinical improvement after empirical treatment for tuberculosis. The control groups included patients with pericardial diseases with moderate to large PE, excluding those whose effusion was cardiac surgery related.
Two reviewers independently selected studies for inclusion in the review and any disagreements were resolved by consensus.