Original Research Article
Year: 2022 | Month: January | Volume: 12 | Issue: 1 | Pages: 201-208
DOI: https://doi.org/10.52403/ijhsr.20220127
A Clinicopathological Study of Fine Needle Aspirates of Lymph Nodes from Patients with Suspected Tubercular Lymphadenopathy: Analysis of 640 Cases from a Tertiary Health Care Centre in North India
Saqib Ahmed1, Hena A Ansari2, Nazish Fatima3
1Junior Resident, Post Graduate, MD Pathology, Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India.
2Associate Professor, MD Pathology, Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India.
3Associate Professor, MD Microbiology, Department of Microbiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India.
Corresponding Author: Saqib Ahmed
ABSTRACT
Introduction: Fine needle aspiration cytology (FNAC) of lymph nodes is an out-patient, simple and, quick, cost-effective procedure that helps in the diagnosis of tubercular lymphadenopathy. This technique has high sensitivity and specificity which in addition to the establishment of cytological diagnosis, also helps to perform ancillary tests like ZN staining for AFB Bacilli and GeneXpert MTB/RIF Assay.
Aims: To study the clinical and cytopathological features of fine-needle aspirates of lymph nodes from patients with suspected tubercular lymphadenopathy along with the role of ZN staining And GeneXpert assay in diagnosis.
Materials and Methods: In this study 1123 patients presenting with lymphadenitis presenting to the cytopathology lab for FNAC of lymph nodes between May 2018 to May 2021 were included. Out of 1123 patients presenting with lymphadenopathies, there were 640 cases of tuberculous lymphadenitis. The clinical and cytopathological findings of these 640 cases were analyzed.
Results: Most cases of tubercular lymphadenopathy were of the adult age group (20-59 years) and showed a female predominance. The most commonly involved lymph node was the cervical group. The most common clinical feature observed was cough (68.5%). Among the four cytomorphological patterns observed, maximum cases showed epithelioid cell granuloma with necrosis. Ziehl- Neelsen staining showed overall AFB positivity of 40.3%. Smear showing necrosis without epithelioid cell granuloma showed maximum AFB positivity among the four patterns.GeneXpert MTB/RIF Assay showed an overall detection rate of 84%.
Conclusion: FNAC is a simple, cost-effective, outpatient technique with high diagnostic accuracy in cases of tubercular lymphadenopathy which can be coupled by Ziehl Staining for Acid-fast bacilli and GeneXpert MTB/RIF Assay. However, in smear-negative cases, it poses a diagnostic dilemma, thus in a developing country like India with a high prevalence rate of tuberculosis, FNAC coupled with Z.N. staining and new molecular tests like GeneXpert MTB/RIF assay should be included in the first-line investigation in cases with tubercular lymphadenopathy.
Key words: Tuberculosis, Fine Needle Aspirate Cytology(FNAC), Necrosis, Epithelioid cells, Cytopathological pattern, Ziehl–Neelsen Staining, GeneXpert Mycobacterium/Rifampicin(MTB/RIF) Assay