Comparison of fine-needle aspiration technique with Ziehl-Neelsen stains in diagnosis of tuberculous lymphadenitis

Abstract

Background: Lymphadenopathy is one of the most common clinical presentation among patients. In developing countries such as India, tuberculous (TB) lymphadenitis is one of the common causes of lymphadenopathy. Cytomorphology with acid-fast staining is a valuable diagnostic tool in cases of tuberculosis.Objective: To describe pattern of TB lymphadenitis presentation, and to compare results of fine needle aspiration cytology (FNAC) and Ziehl-Neelsen (ZN) stain in the diagnosis of TB lymphadenitis.Materials and Methods: Total 351 patients of lymphadenopathy referred to . FNAC was performed in all these patients and smears were prepared. Smears were stained with hematoxylin and eosin stain. ZN staining for acidfast bacilli (AFB) was carried out on separate slide.Results: Maximum number of patients (162; 46.15%) were from age group of 11-30 years. Total 351 cases [179 (50.99%) females and 172 (49.00%) males] were included in the study. Of 351 cases, 173 (49.28%) had tuberculosis, 141 (40.17%) had lymphadenitis other than tuberculosis, and 37 (10.54%) had malignant lymphadenopathy, including 2 (0.56%) cases of primary malignancy (i.e., lymphoma) and 35 (09.97%) of metastasis to lymph nodes. Overall, 119 (33.90%) cases were found to be positive for AFB on ZN staining.Conclusion: FNAC is an optimally selected, efficient, easy to perform, and economical test for initial diagnostic workup in patients with TB lymphadenitis. Supplementation of ZN stain with FNAC increases the rates of diagnosis.

Comparative evaluation of clinical, cytological and microbiological profile in abdominal vs. cervical lymph nodal tuberculosis with special emphasis on utility of Auramine-O staining

“…[ 13 ] Cervical lymph nodes are the most commonly studied site probably due to ease of approachability. [ 13 14 15 16 17 18 19 ] Similarly, abdominal TB has been studied separately in some studies, however, the number of lymph nodes included in the studies is few, with predominant cases being peritoneal and luminal TB. [ 20 21 22 23 ] Moreover, to the best of our knowledge, there are no comparative studies evaluating the cervical and abdominal lymph nodes.…”

“…This was in accordance with most other studies that have reported that most patients present within the second or third decade. [ 14 15 16 17 18 19 22 ] However, some studies show presentation in the higher age groups with a mean age of 39.2 years and 59.5 years. [ 13 20 ] Female preponderance was noted in our study with a male to female ratio of 1: 1.7.…”

“…[ 14 ] and others. [ 15 16 17 18 22 ] In some studies, however, male preponderance was reported. [ 19 20 ]…”

Tuberculous lymphadenitis in South-Eastern Nigeria; A 15 years histopathologic review (2000-2014)

“…Histological demonstration of AFB by Ziehl-Neelsen stain in TB is the goal standard for a diagnosis of TB, but it is notorious for its poor sensitivity,[ 27 37 38 39 40 ] especially in extrapulmonary TB owing to the paucibacillary nature of the specimen,[ 27 ] as well as the effect of formalin and xylene on the stainability of mycobacteria by Ziehl-Neelsen method. [ 39 40 ] In our study, AFB demonstration using Ziehl-Neelsen stain yielded only 15% positivity. This underlies the need for more sensitive techniques such as fluorescence auramine staining, immunofluorescence, and nucleic acid hybridization as necessary diagnostic tools for a more accurate diagnosis of TB lymphadenitis.…”

Efficacy of Fine-Needle Aspiration Cytology in the Diagnosis of Tuberculous Cervical Lymphadenitis

“…However, the former is time-consuming with a low sensitivity in this paucibacillary form of the disease. Fineneedle aspiration cytology (FNAC) is a simple, rapid, and cost-effective diagnostic tool [2].…”