Diagnostic yield of fine needle aspiration biopsy in HIV-infected adults with suspected mycobacterial lymphadenitis

Razack, Rubina; Louw, Mercia; Wright, Colleen A.

doi:10.7196/samj.7492

Cited by 5 publications

(4 citation statements)

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“…FNA is increasingly being used worldwide as a first diagnostic step because of its ease and safety profile, although sensitivity is very variable depending on the study, with positive mycobacterial culture ranging from 10% to 80%. 3 , 4 , 13 – 16 In our study, the yield of AFB detection and mycobacterial culture in both techniques (FNA and biopsy) were similar (25% vs 20.8% of positive Ziehl–Neelsen stain, respectively, and 62.5% vs 64.6% of positive culture, respectively). These results are consistent with those published by Polesky et al 3 in a study with similar characteristics (106 patients, performed in a low tuberculosis incidence setting, and a high proportion of nonnative patients): 21% of positive Ziehl–Neelsen stain and 62% of positive culture from FNA samples, and 26% of positive Ziehl–Neelsen stain and 71% of positive culture from biopsy samples.…”

Section: Discussionsupporting

confidence: 58%

Epidemiology and Diagnosis of Tuberculous Lymphadenitis in a Tuberculosis Low-Burden Country

et al. 2015

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The aim of this article is to describe epidemiological and clinical data of patients with tuberculous lymphadenitis (TL) and evaluate the yield of the diagnostic techniques employed.Retrospective observational study was performed at the Vall d’Hebron University Hospital, Barcelona, Spain. All adult patients with confirmed TL (microbiologically) or probable TL (suspected by clinical presentation, cyto/histopathological features, and clinical improvement after specific treatment) diagnosed from January 2001 to December 2013 were included.One hundred twenty-two patients were included: 78 (63.9%) patients with confirmed diagnosis and 44 (36.1%) patients with probable TL. Seventy (57.4%) patients were nonnative residents. From 83 fine-needle aspiration (FNA) specimens, 54.8% (40/73) showed granulomatous inflammation, 62.5% (40/64) had positive mycobacterial culture, and 73.3% (11/15) tested positive with Xpert MTB/RIF (Cepheid, Sunnyvale, CA). From 62 biopsy samples, 96.8% (60/62) showed granulomatous inflammation, 64.6% (31/48) had positive mycobacterial culture, and 46.1% (6/13) tested positive with Xpert MTB/RIF.TL has increasingly been diagnosed in our setting, mostly because of cases diagnosed in nonnative residents. FNA is an easy and safe technique for the diagnosis of suspected TL, and the yield regarding mycobacterial culture seems to be similar to the obtained with biopsy. The Xpert MTB/RIF test from FNA specimens may increase the accuracy of the TL diagnosis and provides quicker results.

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Section: Discussionsupporting

confidence: 58%

Epidemiology and Diagnosis of Tuberculous Lymphadenitis in a Tuberculosis Low-Burden Country

et al. 2015

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“…We then evaluated the outcomes of fine needle aspiration biopsy in our setting. FNA is widely regarded as the diagnostic modality of choice in diagnosing TB lymphadenitis [ 10 , 21 ]. Our study affirms a good correlation between FNA diagnosis and biopsy diagnosis on lymph node specimens.…”

Section: Discussionmentioning

confidence: 99%

Patterns of Lymph Node Pathology; Fine Needle Aspiration Biopsy as an Evaluation Tool for Lymphadenopathy: A Retrospective Descriptive Study Conducted at the Largest Hospital in Africa

2015

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BackgroundLymphadenopathy is a common clinical presentation of disease in South Africa (SA), particularly in the era of Human Immunodeficiency Virus (HIV) and tuberculosis (TB) co-infection.MethodsData from 560 lymph node biopsy reports of specimens from patients older than 12 years at Chris Hani Baragwanath Academic Hospital (CHBAH) between 1 January 2010 and 31 December 2012 was extracted from the National Health Laboratory Service (NHLS), division of Anatomical Pathology. Cytology reports of lymph node fine needle aspirates (FNAs) performed prior to lymph node biopsy in 203 patients were also extracted from the NHLS. Consent was not obtained from participants for their records to be used as patient information was anonymized and de-identified prior to analysis.ResultsThe majority of patients were female (55%) and of the African/black racial group (90%). The median age of patients was 40 years (range12–94). The most common indication for biopsy was an uncertain diagnosis (more than two differential diagnoses entertained), followed by a suspicion for lymphoma, carcinoma and TB. Overall, malignancy constituted the largest biopsy pathology group (39%), with 36% of this group being carcinoma and 27% non-Hodgkin lymphoma. 22% of the total sampled nodes displayed necrotizing granulomatous inflammation (including histopathology and cytology demonstrating definite, and suspicious for mycobacterial infection), 8% comprised HIV reactive nodes; in the remainder no specific pathology was identified (nonspecific reactive lymphoid hyperplasia). Kaposi sarcoma (KS) accounted for 2.5% of lymph node pathology in this sample. Concomitant lymph node pathology was diagnosed in four cases of nodal KS (29% of the subset). The co-existing pathologies were TB and Castleman disease. HIV positive patients constituted 49% of this study sample and the majority (64%) of this subset had CD4 counts less than 350 cells/ul. 27% were HIV negative and in the remaining nodes, the HIV status of patients was unknown. The most common lymph node pathologies in HIV positive patients were Mycobacterial infection (31%), HIV reactive nodes (15%), non-Hodgkin lymphoma (15%) and nonspecific reactive lymphoid hyperplasia (15%). Only 8.7% were of Hodgkin lymphoma. In contrast, the most common lymph node pathologies in HIV negative patients were nonspecific reactive lymphoid hyperplasia (45%), carcinoma (25%) and Mycobacterial infection (11%). In this group, non-Hodgkin lymphoma and Hodgkin lymphoma constituted 9% and 8%, respectively. There were more cases of high-grade non-Hodgkin lymphoma in the HIV positive group compared to the HIV negative group. FNA and lymph node biopsy had statistically significant good agreement with regard to Hodgkin lymphoma (K 0.774, SE 0.07, 95% CI 0.606-0.882, p=0.001), non-Hodgkin lymphoma (K 0.640, SE 0.07, 95% CI 0.472-0.807, p=0.001), carcinoma (K 0.723, SE 0.069, 95% CI 0.528-0.918, p=0.001), and mycobacterial infection (K 0.726, SE 0.07, 95% CI 0.618-0.833, p=0.001).ConclusionsThe most common lymph node pathologies in CHB...

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“…The history is important and chest X-ray should be obtained but may be normal in the majority. TST may be helpful in non-endemic countries, reported positive in over 85 % of patients, however it may be negative in patients with HIV infection and non-tuberculous lymphadenitis (Razack et al 2014).…”

Section: Extra-thoracic Lymphnode Diseasementioning

confidence: 99%

“…Positive culture from biopsies are reported in between 60 and 80 %, with even higher rates reported fine needle aspiration biopsy (FNAB), which has replaced more invasive biopsies as the diagnostic procedure of choice (Handa et al 2012). The diagnosis of lymph node TB can be achieved with a combination of FNAB cytology (detection of epithelioid cells), AFB smear, PCR and culture in over 80 % of cases (Razack et al 2014).…”

Section: Extra-thoracic Lymphnode Diseasementioning

confidence: 99%

Tuberculosis in Adults and Children

Heemskerk

Caws

Marais

et al. 2015

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Diagnostic yield of fine needle aspiration biopsy in HIV-infected adults with suspected mycobacterial lymphadenitis

Cited by 5 publications

References 10 publications

Epidemiology and Diagnosis of Tuberculous Lymphadenitis in a Tuberculosis Low-Burden Country

Epidemiology and Diagnosis of Tuberculous Lymphadenitis in a Tuberculosis Low-Burden Country

Patterns of Lymph Node Pathology; Fine Needle Aspiration Biopsy as an Evaluation Tool for Lymphadenopathy: A Retrospective Descriptive Study Conducted at the Largest Hospital in Africa

Tuberculosis in Adults and Children

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