Aggarwal AN, Agarwal R, Dhooria S, et al. - Researchers examined the diagnostic performance of pleural fluid tumor necrosis factor (TNF) to detect tuberculous pleural effusion (TPE), as well as assessed whether it is able to differentiate TPE from parapneumonic or malignant effusions. Studies indexed till August 2020 were identified from PubMed and Embase databases. A total of 1,090 citations were retrieved, and 38 publications were included. For sensitivity, specificity, and diagnostic odds ratio, the summary estimates were 0.79, 0.82, and 16.84 respectively. Significantly higher pleural fluid TNF concentrations were identified in TPE vs in malignant effusions, but not parapneumonic effusions. Overall, findings pointed to poor diagnostic accuracy of pleural fluid TNF for diagnosing TPE. In addition, pleural fluid TNF imperfectly distinguished TPE from parapneumonic pleural effusions.