India accounts for 23% of global TB burden. Of these 38% are of Extra Pulmonary Tuberculosis.Lymph node TB is the most common EPTB, pleural effusion is second most common type of EPTB in India. The bacteriological confirmation to diagnose EPTB is more difficult due to its pauci-bacillary nature.This study aims assessing the comparison of ADA with Gene-Xpert MTB RIF in pleural fluid in the diagnosis of tubercular pleural effusion. Study was a cross-sectional studycarried out at the Department of Respiratory Medicine and Department of Internal Medicine, Muzaffarnagar Medical College, and School of Medical Science and Research,Greater Noida, Gautam Budh Nagar,UP from January 2018 to March 2019.Paired and unpaired Student's t-test, Chi square test, P < 0.05 was considered statistically significant;SPSS 18.0 software was used for analysis. The detection of MTB and rifampicin resistance using the Gene-Xpert MTB/RIF with pleural fluid ADA assay was assessed in 66 specimens. With ADA cut off as 40IU/L, 60 cases had an ADA > 40IU/L and 6 cases had ADA < 40IU/L. Pleural fluid Gene-Xpert detected MTb in 22 samples while in 44 samples MTB not detected.All pleural fluid MTb detected by Gene-Xpert were rifampicin sensitive. Gene-Xpert detected 2 tubercular pleural effusion in which ADA level was less than 40.Study shows that there was no statistically significance in diagnostic value between Gene-Xpert and ADA pleural fluid however Gene-Xpert MTB/RIF is useful method for rapid detection of MTB and Rifampicin resistance simultaneously. Estimation of ADA in pleural fluid is rapid inexpensive laboratory investigation where the diagnosis is uncertain.We found no significant connection between CBNAAT positivity and ADA level. In developing country lymphocyte predominant effusions with high ADA levels (> 40 U/L) is better option but definitely combined use of ADA and GeneXpert is better than using individually for the diagnosis of Tubercular pleural effusion

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