The value of histological examination in the diagnosis of tuberculous lymphadenitis in the era of rapid molecular diagnosis

Abstract

Extrapulmonary tuberculosis often poses a diagnostic challenge. This study aimed to assess the value of histological examination in diagnosing tuberculous lymphadenitis (LNTB) when performed simultaneously with rapid molecular assay (Xpert MTB/RIF) testing. People presumed to have LNTB were prospectively enrolled in a tertiary care hospital. Excision biopsy was performed and tested by histology, Xpert, and culture. Of 390 lymph nodes, 11 (2.8%) were positive by AFB microscopy, 124 (31.8%) by Xpert, 137 (35.1%) by culture, and histopathology was consistent with TB in 208 (53.3%). Altogether, LNTB was diagnosed in 228 and bacteriologically confirmed TB in 178 cases. Against culture, histopathology versus Xpert had higher sensitivity (93 vs. 62%) but lower specificity (68 vs. 83%). In patients with short clinical history, a significantly higher number of Xpert-positive specimens were culture-positive. Among patients with histology suggestive of TB, no difference was seen in response to treatment between bacteriology positive and negative, but a significant slow response was noted in bacteriology confirmed TB with nonspecific histology. In a country like Pakistan, with high TB and low HIV prevalence, diagnosis is possible for more than 95% of LNTB when Xpert and histopathology examination is used in combination, compared to less than 60% by Xpert alone.

Diagnosis of extrapulmonary tuberculosis by ultrasound-guided biopsy: A retrospective comparison study

“…Obtaining appropriate specimens for histological examinations was recommended for a patient with suspected EPTB ( Hopewell et al., 2006 ; Migliori et al., 2018 ). In general, histopathology is highly sensitive (86%-95% reported; HE: 92.4% [85.7-96.1] and AFB: 81.7% [73.2-88.0] in this study), but not very specific (64%-92% reported; HE: 71.3% [61.0-79.7] and AFB: 73.3% [63.1-81.5] in this study), for the diagnosis of tuberculosis ( Bennani et al., 2019 ; Shen et al., 2022 ; Tahseen et al., 2022 ).…”

“…Auramine O staining is not able to distinguish between dead or live bacteria, but culture only detects viable bacteria, thus NaOH used in sample pre-treatment may result in lower sensitivity of culture than smear. Obtaining appropriate specimens for histological examinations was recommended for a patient with suspected EPTB (Hopewell et al, 2006;Migliori et al, 2018) : 73.3% [63.1-81.5] in this study), for the diagnosis of tuberculosis (Bennani et al, 2019;Shen et al, 2022;Tahseen et al, 2022).…”

Otitis media tuberculosa pediátrica, un desafío diagnóstico. Revisión de la literatura a propósito de un caso

“…En cuanto a la histopatología, ésta dará el diagnóstico certero en hasta el 88% de los casos, encontrándose hallazgos característicos al cultivo como lo son la presencia de granulomas caseificantes, presencia de BAAR, células gigantes multinucleadas y células epitelioides 9,11,28 .…”

Characterization of chemokine and cytokine expression pattern in tuberculous lymphadenitis patient

“…Epithelioid cells may also fuse to form multinucleated giant cells, and central necrosis is evident in necrotizing granulomas. Caseous necrosis and granulomatous formation are two specific pathological features of LN TB (6,7).…”