Abstract
BackgroundThe frequency of occurrence of extrapulmonary tuberculosis (EPTB) has been increasing globally over the last two decades. In Morocco, EPTB cases account for 46% of the patients reported with a new episode of tuberculosis (TB). Lymph node TB (LNTB) is the most common form of EPTB. In line with the guidelines of the National TB Program, the diagnosis is mainly based on clinical evidence, including histopathology.ObjectiveThis study aimed to evaluate the yield of histopathology testing in the diagnosis of LNTB.MethodsThis cross-sectional, prospective study was conducted among patients with cervical lymph node who were enrolled in the study from November 2016 to May 2017 in three regions of Morocco. We compared the outcomes of histopathological testing with those of bacteriology. Sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) of histopathology testing were calculated. Culture and Xpert tests were used as the gold standard Laboratoty Testing.ResultsA total of 262 patients were enrolled in this study. The Se, Sp, PPV, and NPV of histopathology testing were 95.6% (129/135), 64.6% (82/127), 74.1% (129/174), and 93.2% (82/88), respectively, in the presence of granuloma with or without caseous necrosis and were 84.4% (114/135), 74.8% (95/127), 78.1% (114/146), and 81.9% (95/116), respectively, in the presence of granuloma with caseous necrosis. The granuloma with caseous necrosis was associated with increased PPV and Sp of histopathology testing (P<.05).ConclusionsThe presence of the granuloma with caseous necrosis in the histopathological examination had significantly improved the yield of histopathology testing for the diagnosis of LNTB. The findings recommend to maintain histopathology testing in establishing the LNTB diagnosis and to explore other techniques to improve it.
Highlights
Tuberculosis (TB) continues to challenge the international community
This cross-sectional, prospective study was conducted among patients with cervical lymph node who were enrolled in the study from November 2016 to May 2017 in three regions of Morocco
The granuloma with caseous necrosis was associated with increased positive predictive value (PPV) and Sp of histopathology testing (P<.05)
Summary
Tuberculosis (TB) continues to challenge the international community. The global burden is estimated by the World Health Organization (WHO) at 10.4 million incident cases in 2016 [1]. The proportion of extrapulmonary TB (EPTB) cases has not exceeded 15% among all notified patients with TB for many years [1,2,3]. The WHO Eastern Mediterranean Region (EMR) has the highest percentage of notified EPTB cases; 22% to 24% of patients diagnosed with TB each year have EPTB [1,2,3]. Among the EMR countries, Tunisia has the highest proportion of EPTB cases with 60% [3]. High proportions are reported in Algeria (63%), Syria (47%), Egypt (43%), and Saudi Arabia (26%) [1]. The frequency of occurrence of extrapulmonary tuberculosis (EPTB) has been increasing globally over the last two decades. In Morocco, EPTB cases account for 46% of the patients reported with a new episode of tuberculosis (TB). In line with the guidelines of the National TB Program, the diagnosis is mainly based on clinical evidence, including histopathology
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