頸部リンパ節結核29症例の臨床的検討<br>—診断における低侵襲な穿刺吸引法の位置づけ—

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The diagnosis of cervical tuberculous lymphadenitis has been performed by histological examination using excisional biopsy specimens. However a non-invasive diagnostic procedure alternative to invasive excisional biopsy has been required and fine needle aspiration cytology as well the polymerase chain reaction (PCR) technique have become useful modalities. The aim of this study was to clarify the effectiveness of needle aspiration as a less invasive and more rapid diagnostic procedure than excisional biopsy. Twenty-one excisinal biopsy specimens and 20 needle aspiration specimens were collected from 29 patients who were diagnosed as having cervical tuberculous lymphadenitis. The detection of mycobacterium tuberculosis with a smear microscopy was performed in 20 specimens, with the culture method in 20 and with the PCR test in 14 specimens. The histopathological positive rates, the detection ratio of mycobacterium, the rupture rate of the local skin lesion and the period necessary for diagnosis were compared between the two percutaneous approaches. The diagnosis of tuberculous lymphadenitis was successful in all cases either by cytological examination in 8 of 21 (40%) or with the histological approach in the other 21 cases. The detection ratios of smear, culture and PCR were 20%, 40% and 64%, respectively. The rupture rate of the local skin after the excisional biopsy was higher than that of the needle aspiration procedure (p = 0.05). The period for diagnosis was significantly longer than that of the needle aspiration procedure (p < 0.001). As a less invasive method of diagnosis of cervical tuberculous lymphadenitis, cytology as well as the detection of mycobacterium using an aspiration procedure is highly recommended.