The need to reassess the value of fine needle aspiration in the diagnosis of tuberculous cervical lymphadenitis in Iran

Abstract

Iran is an endemic country for tuberculosis (TB). After the eradication and efficient control of some priority infectious diseases such as polio and measles TB has now turned into a major public health problem in Iran. Cervical lymphadenitis is the most common form of extrapulmonary TB accounting for 30-40% of TB cases and fine needle aspiration (FNA) is widely accepted as the first diagnostic modality of choice in this entity especially in countries where mycobacterial infection is endemic. FNA is easy safe rapid and noninvasive compared to excisional biopsy which is usually considered the second choice. It is readily available in most centres and can safely be performed in outpatient departments. The diagnostic accuracy of FNA for tuberculous cervical lymphadenitis varies considerably among different studies with a reported sensitivity of 25-100%. This variation might be due to differences in geographical location and endemicity expertise of the clinician and pathologist and the time lapsed before the lymphadenopathy comes to the patients attention. Recently we became aware of several small informal reports from different regions in our country warning about high false negative rates of FNA results and that seemed especially worrying in cases of patients who referred early in the course of their disease. Therefore we opted to assess the issue of FNA sensitivity for (early) tuberculous cervical lymphadenitis in Iran for the first time. (excerpt)