Purpose of reviewT-cell interferon-gamma release assay (IGRA) use in tuberculosis (TB) contactscreening and latent TB diagnosis is established and supported by American andEuropean guidelines. However, questions remain regarding their clinical utility beyondconventional tests in the investigation of suspected active TB. We review the evidencebase for IGRAs in the diagnosis or exclusion of pleural TB.Recent findingsThe specificity of IGRAs for diagnosis of active TB disease is limited by an inabilityto distinguish latent disease. The test’s sensitivity when applied to the blood of patientswith active TB is diminished by compartmentalizing of sensitized T cells at thedisease site. To circumnavigate these problems, recent studies explore the value ofapplying IGRAs to pleural fluid. Results have varied between patient populations, butthe strategy does not appear to completely eliminate false-positive results.SummaryAccurate biomarkers of pleural TB are useful, particularly for their negative predictivevalue. IGRAs are technically more complicated and expensive than establishedbiomarkers, and their diagnostic performance for active pleural TB is highly variablebetween studies and settings. Currently, there is inadequate evidence to support theuse of IGRAs in the diagnosis or exclusion of active pleural TB, particularly in centreswhere adenosine deaminase and interferon-gamma assays are available.