A cytological study of smear characteristics and its correlation with bacillary load in tubercular lymphadenopathy

Abstract

Abstract Introduction: Extrapulmonary tuberculosis in form of lymphonodes is the common presentation of tuberculosis in developing countries. Fine needle aspiration cytology helps in early diagnosis & treatment for tubercular lymphadenitis, which remains the cornerstone for the effective management of the disease. Aim: To study the cytological characteristics and compare with the bacteriological load with the help of Zeihl Neelsen stain. Materials and Methods: 445 smears were studied for a period of one year. Smears were categorized into 4 patterns Pattern A - epithelioid cell granulomas without caseous necrosis, Pattern B -epithelioid cell granulomas with caseous necrosis, Pattern C- caseous necrosis without granuloma, Pattern D – neutrophils with abundant caseous necrosis. Bacillary load was graded as 1+, 2+ and 3+ were compared with the cytological categories. A p value of Results: Pattern A was observed in 16.7% cases, Pattern B in 18.3%, Pattern C in 37.8% & Pattern D in 27.2% of cases. Statistical significance was seen between cytomorphological pattern & AFB grade (p=0.026 & X2=20.0639). It was found that pattern C& D showed the highest AFB grade of 3+ by a 2x2 analysis to test the degree of one hypothesis. Conclusion: FNAC is an useful tool in the early diagnosis of tubercular lymphadenitis avoiding the un necessary burden of surgical intervention. Maximum bacillary load was correlated with the patterns C & D. Keywords: Fine needle aspiration cytology, Tuberculosis, Lymph nodes, Caseous necrosis, Acid fast bacilli. Introduction Tuberculosis is a major public health problem worldwide, especially in the developing countries like India. Peripheral lymphadenopathy is the most common manifestation of extrapulmonary tuberculosis.[1],[2]Fine Needle Aspiration Cytology (FNAC) is safe, cost effective and conclusive procedure.[3] It provides an alternative to excision biopsy for lymph nodes and is an easy procedure for collection of