Abstract
Opportunistic infections and malignancies cause lymphadenopathy in HIV-infected patients. The use and accuracy of fine needle aspiration cytology in diagnosing of cervical lymphadenopathy among HIV-infected patients is not well studied in Uganda. The aim of this study was to determine the diagnostic accuracy of fine needle aspiration cytology in providing a diagnosis of cervical lymphadenopathy among HIV-infected patients in Uganda. We consecutively recruited adult HIV-infected patients with cervical lymphadenopathy admitted to Mulago Hospital medical wards. Clinical examination, fine needle aspiration and lymph node biopsy were performed. We estimated the sensitivity, specificity; negative and positive predictive values using histology as the gold standard. We enrolled 108 patients with a mean age of 33 years (range, 18-60), 59% were men and mean CD4 was 83(range, 22-375) cells/mm(3). The major causes of cervical lymphadenopathy were: tuberculosis (69.4%), Kaposi's sarcoma-KS (10.2%) and reactive adenitis (7.4%). Overall fine needle aspiration cytology accurately predicted the histological findings in 65 out of 73 cases (89%) and missed 7 cases (9.5%). With a sensitivity of 93.1%, specificity of 100%, positive predictive value of 100% and negative predictive value of 78.7% for tuberculosis and 80%; 98.4%;88.9% and 98.9% for KS respectively. No fine needle aspiration complications were noted. Fine needle aspiration cytology is safe and accurate in the diagnosis of tuberculosis and KS cervical lymphadenopathy among HIV-positive patients.
Highlights
IntroductionFine needle aspirate cytology (FNAC) has assumed an important role in the diagnosis of peripheral lymphadenopathy as an alternative procedure which is less invasive, faster and cheaper than excision biopsy.[6,7,8] fine needle aspirate cytology (FNAC) has not been widely utilized in Uganda, as most clinicians still use surgical excision biopsies
Significant asymmetrical lymphadenopathy is a common problem in HIV infected adults
We determined the diagnostic accuracy of fine needle aspirate cytology (FNAC) in the evaluation of cervical lymphadenopathy in adult HIV-infected patients and established the common causes in Mulago national referral hospital. Participants This was a cross-sectional study of diagnostic accuracy in which we consecutively recruited adult HIV-infected patients with cervical lymphadenopathy who were admitted to Mulago national referral hospital medical wards in Kampala, Uganda, between February 2007 and June 2007
Summary
Fine needle aspirate cytology (FNAC) has assumed an important role in the diagnosis of peripheral lymphadenopathy as an alternative procedure which is less invasive, faster and cheaper than excision biopsy.[6,7,8] FNAC has not been widely utilized in Uganda, as most clinicians still use surgical excision biopsies. The use and accuracy of fine needle aspiration cytology in diagnosing of cervical lymphadenopathy among HIV-infected patients is not well studied in Uganda. Objective: The aim of this study was to determine the diagnostic accuracy of fine needle aspiration cytology in providing a diagnosis of cervical lymphadenopathy among HIV-infected patients in Uganda. Conclusions: Fine needle aspiration cytology is safe and accurate in the diagnosis of tuberculosis and KS cervical lymphadenopathy among HIV-positive patients.
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