Can cytomorphology of granulomas distinguish sarcoidosis from tuberculosis? Retrospective study of endobronchial ultrasound guided transbronchial needle aspirate of 49 granulomatous lymph nodes

Abstract

Background:The differential diagnosis of tuberculosis (TB) and sarcoidosis on fine needle aspiration material is very challenging in tubercular endemic regions. We carried out a pilot study to explore cytomorphologic features of granulomas which could help in differentiation between sarcoidosis and TB. Final diagnoses in these patients were based on clinical, microbiologic and follow-up studies.Materials and Methods:Endobronchial ultrasound guided transbronchial needle aspiration smears of 49 consecutive patients with a final cytologic diagnosis of granulomatous lymphadenitis were reviewed. Based on cytologic features two cytologic categories were enunciated and the results were correlated with microbiologic studies and/follow-up of minimum of 6 months.Results:The cytologic categories did not correlate with the final clinical outcome of patients.Conclusions:Different patterns of granulomas observed in cytology smears do not help distinguish TB from sarcoidosis. The novel non-invasive techniques of mediastinal sampling though help in confirming granulomatous pathology, distinction between these entities and treatment decisions still depend upon correlating cytologic, microbiologic, clinical and radiological data in a large number of cases in tubercular endemic regions.

Diagnostic Value of Convex Probe Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Mediastinal Tuberculous Lymphadenitis: A Systematic Review and Meta-Analysis

“…The quality of the included studies was generally good with the median (IQR) score of 18 ( Table 2 ). Of the 14 included studies, 7 were prospective [ 10 , 21 , 23 , 26 , 27 , 29 , 33 ], and 7 were retrospective [ 22 , 24 , 25 , 28 , 30 – 32 ]. A total of 11 patients presented with isoniazid-resistant TB [ 25 , 26 , 31 ], and 25 patients presented with human immunodeficiency virus (HIV)-related TB [ 25 , 33 ].…”

“…Five studies used conscious sedation with midazolam [ 10 , 21 , 23 , 28 , 29 ], while 8 studies used intravenous anesthesia [ 22 , 24 – 27 , 30 , 31 , 33 ] with fentanyl or propofol to assist the anesthesia and lidocaine as the topical throat anesthetic ( Figure 1 ). The 1 remaining study could not provide this information [ 32 ].…”

Granuloma of the labial minor salivary glands in tuberculosis

“…A cytological examination may be useless since features of granulomas are nonspecific although polymorphonuclear leukocytes may be observed. [ 5 ] The histological diagnosis may also be rendered difficult by the lack of necrosis and by the absence of AARB on the Ziehl–Neelsen-stained tissue section. However, necrosis is reported to lack in minor salivary gland granulomas from patients with tuberculosis, isolated, or supposed associated to sarcoidosis.…”

Tuberculosis revisited: Cytological perspective

“…Stain for AFB is consistently negative. However, sarcoidosis cannot be differentiated from non‐necrotic tuberculosis only by cytomorphology and other clinical and biochemical parameters should be taken into account . Fungal granulomas on the other hand are usually accompanied by necrosis and mixed inflammatory infiltrate composed of neutrophils, eosinophils, and lymphocytes.…”