Abstract
Introduction: Fine needle aspiration cytology (FNAC) is widely accepted as the accurate, sensitive, specific and cost-effective procedure in the diagnosis of lymphadenopathy. Tubercular lymphadenitis is one of the most common causes of lymphadenopathy in developing countries like India. Materials and Methods: An observational study was carried out at the pathology department of teaching hospital in Delhi NCR from March 2013 to April 2017. A total of 3392 patients presented in the FNAC OPD of the hospital, out of which 1730 had lymphadenopathies. Smears were stained with Giemsa and categorised into the cytological pattern. Zheil Neelson (ZN) stain was done in all clinically suspicious cases to tuberculosis. Data regarding brief history, site, age, sex, the gross appearance of aspirate and cytomorphologic features were collected and analysed. Results: Out of the 1730 cases of consecutive lymph node aspirations, 17 were excluded from the study due to inadequate material, 979 cases (57.15%) showed features of Tubercular Lymphadenitis followed by Reactive Lymphadenitis, 524 cases (30.58%). Out of the 20 cases which showed HIV positivity 18 showed the presentation of tubercular lymphadenitis. TB was prevalent in all age groups, with the majority of cases affecting people more than 50 years of age. Conclusion: FNAC of lymphadenopathy is of particular importance in view of the high prevalence of tuberculosis in our country, atypical presentation of tuberculosis and because AFB are seen mostly in purulent aspirate smears which do not show granulomas, necrosis or epithelioid cells and which in the absence of Ziehl-Neelsen staining can be dismissed as acute suppurative lymphadenitis. FNAC is a simple, reliable, quick and economical diagnostic tool for peripheral lymph node lesions especially in the quick and simple diagnosis of Tubercular Lymphadenitis. Keywords: Lymph node, Fine needle aspiration cytology FNAC, Tubercular lymphadenitis, Reactive lymphadenitis, Lymphoma.
Highlights
Fine needle aspiration cytology (FNAC) is widely accepted as the accurate, sensitive, specific and cost-effective procedure in the diagnosis of lymphadenopathy
The cases were divided into eight categories: 1. Tubercular lymphadenitis - revealed necrotic material, epitheloid cells, lymphocytes and an occasional giant cell
Dudgeon and Patrick in 1927 first used FNAC in diagnosing TB lymphadenitis followed by Tempka and Kubiczek, Mahanta et al 11 In our clinical setting, tubercular lymphadenitis constituted 57.2% of all lymph node aspirates and was the most common cause of lymphadenopathy
Summary
Fine needle aspiration cytology (FNAC) is widely accepted as the accurate, sensitive, specific and cost-effective procedure in the diagnosis of lymphadenopathy. Conclusion: FNAC of lymphadenopathy is of particular importance in view of the high prevalence of tuberculosis in our country, atypical presentation of tuberculosis and because AFB are seen mostly in purulent aspirate smears which do not show granulomas, necrosis or epithelioid cells and which in the absence of Ziehl-Neelsen staining can be dismissed as acute suppurative lymphadenitis. The histopathological examination is considered to be the gold standard in diagnosis especially in lymphomas, FNAC may be the more accessible tool for diagnosis and further management of the patients in some cases of metastatic malignancy because it is a quick and rapid procedure with low processing time.
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