Fine-needle aspiration has a very low sensitivity in the diagnosis of tuberculous cervical lymphadenitis in Iran
Abstract number: 1733_643
Hasibi M., Rezaei J., Madani Kermani Z., Asadollahi M., Abouzari M., Rashidi A.
Objectives: To assess the issue of fine-needle aspiration (FNA) sensitivity for early tuberculous cervical lymphadenitis in Iran for the first time.
Methods: The results of FNA in 46 consecutive patients (12 Afghan, 34 Iranian) with cervical lymphadenopathy who had a definitive diagnosis of tuberculous cervical lymphadenitis were retrospectively evaluated. Definitive diagnosis was established on the presence of caseous necrosis with epitheloid-cell granulomas at histopathologic evaluation of the nodes after excisional biopsy. Smear (with Giemsa staining) and culture (with ZiehlNeelsen's staining) for acid-fast bacilli on FNA specimens were available in 35 and 29 cases, respectively. All patients had a negative serology for HIV infection. A skin tuberculin test (PPD) had been performed on all patients.
Results: There were 13 males and 33 females ranging in age from 12 to 70 years with a mean age of 39.6 years. Lymphadenopathy ranged in duration from 15 days to 2 years with a mean of 55 days. PPD test, smear and culture were positive in 41 (89%), 1 (2.8%) and 1 (3.4%) cases, respectively. FNA results were nonspecific acute and/or chronic inflammation without necrosis or granuloma in 34 (73.9%), granuloma without necrosis in 3 (6.5%), malignancy in 5 (10.8%) and granuloma with caseous necrosis in 4 (8.7%) patients. Based on these results, if one defines a positive test as one revealing granuloma with caseous necrosis which is the characteristic finding of tuberculous lymphadenitis, then the sensitivity of FNA will be only 8.7%. Even if we regard the samples with granuloma but without necrosis as positive, the sensitivity will still be only slightly higher than 15%. Of particular note, more than 84% of samples did not show a granuloma, which made TB involvement seem less likely. Also, smear and culture could not increase the sensitivity significantly, each being positive in less than 4% of patients only.
Conclusion: The advantages of an early definite diagnosis even with the aid of an invasive procedure such as excisional biopsy should be carefully assessed against the disadvantages of high false negative rates obtained from a relatively non-invasive procedure like FNA.
|Session name:||European Society of Clinical Microbiology and Infectious Diseases|
|Location:||ICC, Munich, Germany|
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