Diagnosis Of Cervical Tuberculous Lymphadenitis Research Articles

Diagnostic Accuracy of FNAC in Tuberculous Cervical Lymphadenitis- Experience from a Tertiary Care Centre

Objective: To analyze the role of Fine Needle Aspiration Cytology (FNAC) in the detection of tubercu- lous cervical lymphadenitis. Methods: A retrospective cross-sectional study was carried out at the Dr. Ruth K. M. Pfau Civil Hospi- tal Karachi’s ENT-Head and neck surgery department, from April 2021 till March 2022. Patients with ages between 30-70 years having cervical lymphadenopathy lasting for more than or equal to 3 months and having 1 or more palpable lymph nodes of more than or equal to 1 cm were included in the study. A questionnaire was designed for data collection from the patients. The names, ages, gen- der of the patients, the duration of disease noted down. The dominating nodes’ FNAC and ultrasound neck were done. Inconclusive FNAC were followed by excisional biopsy. The sample size was taken as 50, with analysis done through SPSS version 23. Results: There were 34 (64%) females and 16 (32%) males present. The patients’ average age was 52.94 ± 9.43 years; 33 patients were below the age of 55, out of which 25 (75.7%) had positive and 8 (24.2%) had negative FNAC. Of the patients over the age of 55, 11 (64.7%) had positive and 6 (54.5%) had negative FNAC. The illness lasted 5.84 ± 2.63 months on average, 2 months being the minimum duration of disease, while maximum duration was 15 months. The duration of less than or equal to six months was observed in 40 (80%) and the duration of more than 6 months was ob- served in 10 (20%) of patients. With a mean size of 2.5 ± 1.14 cm, 29 patients (58%) had unilateral nodes and 21 (42%) had bilateral nodes. FNAC has a sensitivity of 97% and specificity of 72.2%, meaning that it was positive in 36 individuals and negative in 14. Conclusion: FNAC plays a significant role in the diagnosis of tuberculous cervical lymphadenitis.

A combination of ultrasound and contrast-enhanced ultrasound improves diagnostic accuracy for the differentiation of cervical tuberculous lymphadenitis from primary lymphoma.

To present a method combining ultrasound (US) and contrast-enhanced ultrasound (CEUS) features for differential diagnosis of cervical tuberculous lymphadenitis (CTL) and primary lymphoma. A total of 155 patients with CTL (n = 49) and lymphoma (n = 106) who underwent US and CEUS were retrospectively included. The features extracted from US and CEUS and the significant clinical data were created three models using the least absolute shrinkage and selection operator and logistic regression analysis. The diagnostic performance of the models was assessed using the area under the curve (AUC). The combined model outperformed US model and CEUS model in distinguish CTL from lymphoma achieved favorable performances in training set and validation set with AUCs of 0.958 and 0.946 as well as high accuracies (91.7% and 87.2%), sensitivities (95.9% and 84.4%) and specificities (82.4% and 93.3%). Delong's test showed that among the three models, combined model was significantly different from the other two models in training set (p = 0.011 and 0.029, respectively) and validation set (p = 0.018 and 0.001, respectively). A combination of US and CEUS achieved good diagnostic performance in differentiating lymphoma and CTL, which might aid in clinical decision-making.

HBHA-IGRA and cytotoxic mediators release assays for the diagnosis of cervical tuberculous lymphadenitis.

Cervical tuberculous lymphadenitis (CTL), the most frequent extrapulmonary form of tuberculosis, is a serious health problem in Tunisia. CTL diagnosis is challenging mainly due to the paucibacillary nature of the disease and the potential misdiagnosis as cervical non-tuberculous lymphadenitis (CNTL). Here, we evaluated the performance of heparin-binding hemagglutinin (HBHA) interferon-gamma (IFN-γ) release assay (IGRA) for the diagnosis of CTL. In addition, we evaluated granzyme B, granulysin, and perforin release assays as CTL biomarkers and assessed their potential contribution to improve HBHA-IGRA performance. Peripheral blood mononuclear cells from CTL-suspected patients were stimulated with HBHA, early secreted antigenic target 6 (ESAT-6), or purified protein derivative (PPD) for 24 h in the presence of IL-7. Cytotoxic mediators and IFN-γ release were assessed by enzyme-linked immunosorbent assay. Receiver operating characteristic curves were used to evaluate the capacity of HBHA, ESAT-6, and PPD to discriminate between CTL (n = 27) and CNTL (n = 21). After applying bivariate and multivariate analyses, IFN-γ responses to HBHA appeared to offer the best distinction between CTL and CNTL, with an area under the curve of 0.9947, associated with 95.24% and 100% sensitivity and specificity, respectively. A principal component analysis showed clear clustering of the CTL versus the CNTL groups. This clustering was mainly attributed to HBHA-induced IFN-γ, PPD-induced granzyme B, and PPD-induced IFN-γ. These results thus suggest that the HBHA-IGRA provides high diagnostic accuracy for CTL versus CNTL, with high sensitivity and specificity. Combining HBHA-induced IFN-γ and PPD-induced granzyme B improves the accuracy to identify CTL.IMPORTANCECervical tuberculous lymphadenitis (CTL), the most frequent extrapulmonary form of tuberculosis, is currently a major health problem in Tunisia and in several regions around the world. CTL diagnosis is challenging mainly due to the paucibacillary nature of the disease and the potential misdiagnosis as cervical non-tuberculous lymphadenitis. This study demonstrates the added value of the heparin-binding hemagglutinin-interferon-gamma release assay as an immunoassay in the context of CTL.

Cervical tuberculous lymphadenitis

Background: Diagnosis of cervical tuberculous lymphadenitis has been challenging to clinicians as it mimics multiple diseases. USG has upper hand over other diagnostic modalities as it is non- invasive, low cost, time saving and guided procedures like FNAC and core needle biopsy can be performed. Methods: This is a prospective observational study conducted in 100 patients from June 2019 to May 2020 in Dept of Pulmonary medicine, PRM Medical College and Hospital, Baripada. A complete clinical examination, routine blood investigations, CXR, USG Neck, FNAC and CBNAAT were done and data was recorded. Results: Maximum numbers of patients were in age group of 11-20 years (38%) followed by 21-30 years (32%) and presented between the duration of 1-3 months. There were 44(44%) males and 56(56%) females; male to female ratio was 1:1.3. Most of the patients (70%) did not have any constitutional symptoms and maximum number of patients i.e. 53% had matting of LN followed by discrete node 29% whereas 10% patients presented with abscess and 8% had discharging sinuses. In USG, 46 (46%) showed cervical lymphadenopathy with tubercular aetiology with sensitivity and specificity of 90% and 50% respectively with accuracy of 88%.

The diagnostic value of contrast-enhanced ultrasound for cervical tuberculous lymphadenitis.

OBJECTIVE:To investigate the value of contrast-enhanced ultrasound (CEUS) for the diagnosis of cervical tuberculous lymphadenitis (CTL).METHODS:The cohort study included 203 consecutive patients diagnosed with cervical lymph node. Before pathological or laboratory confirmation, all patients underwent CEUS examination, and the imaging findings were analyzed afterward. The diagnostic efficiency of the CEUS imaging findings of CTL was evaluated.RESULTS:Nighty-seven patients of the 203 (47.8%) were pathologically or laboratory confirmed with a CTL diagnosis while the remainder (52.2%) were diagnosed with non-tuberculous lymphadenitis. Regarding the imaging findings of CEUS, it was more common in CTL patients to find a pattern of heterogeneous enhancement inside the lymph nodes relative to non-tuberculous patients [81.44% (79/97) vs 15.09% (16/106), P < 0.01]. The sensitivity of the feature in diagnosis for CTL was 81.44% and the specificity was 84.91%, resepectively. Furthermore, a pattern of peripheral rim-like enhancement had been notable in CTL patients compared with non-tuberculous patients [86.60% (84/97) vs 12.26% (13/106), P < 0.01], associating with a diagnostic sensitivity of 86.60% and a specificity of 87.74%. When it came to the combination of both imaging findings mentioned above, the features were more prominent in CTL patients than compared with non-tuberculous patients [74.23% (72/97) vs 5.66% (6/106), P < 0.01], with a diagnostic sensitivity of 74.23% and a high specificity of 94.34%. Regarding area under curve (AUC) for the ROC analysis, the feature of internal heterogeneous enhancement, peripheral rim-like enhancement, and both features were 0.832, 0.872, and 0.843.CONCLUSIONS:CEUS patterns of heterogeneous enhancement and peripheral rim-like enhancement of lymph nodes are helpful characteristics for the diagnosis of CTL.

To Study the Role of Gene Xpert in the Diagnosis of Tuberculous Cervical Lymphadenitis

Role of Gene Xpert in the diagnosis of Tuberculous Cervical Lymphadenitis was determined and compared with FNAC. Female preponderance is seen in present study in the cases of cervical lymphadenopathy. Caseous material of the lymph nodes had a higher yield. CBNAAT with FNAC is highly effective in the diagnosis of Tuberculosis. CBNAAT has an important role in the diagnosis of Extra Pulmonary Tuberculosis.

Reassessing the Value of Contrast-Enhanced Ultrasonography in Differential Diagnosis of Cervical Tuberculous Lymphadenitis and Lymph Node Metastasis of Papillary Thyroid Carcinoma.

AimWe aimed to evaluate the ability of contrast-enhanced ultrasonography (CEUS) to perform differential diagnosis of cervical tuberculous lymphadenitis and lymph node metastasis from papillary thyroid cancer (PTC).MethodsWe analyzed 102 enlarged cervical lymph nodes as diagnosed by conventional ultrasound (US) and CEUS. The US and CEUS enhancement pattern and the time intensity curve (TIC) of the metastatic lymph nodes or tuberculous lymph nodes were compared following standard pathological protocols. The TIC included peak time (TTP), peak intensity (PI), and area under the gamma curve (AUC).ResultsPathological results demonstrated that 48 out of the 102 enlarged lymph nodes were lymph node metastasis from PTC, while 54 were tuberculous lymphadenitis. There was statistically significant differences in hyperechoic islands, pulse-like enhancement, and asynchronous enhancement between tuberculous lymphadenitis and lymph node metastasis (P < 0.05), but their diagnostic sensitivity and specificity were unsatisfactory. In addition, our data did not show statistically significant difference in enhancement direction, enlarged range on CEUS, and perfusion defect (P > 0.05). Similarly, quantitative parameters such as PI, TTP, and AUC did not yield significant differences between the groups.ConclusionTaken together, the present results demonstrate that CEUS can provide valuable information on lymph node blood flow, which can be used to identify tuberculous lymphadenitis and lymph node metastasis of PTC.

Role of ultrasound in the diagnosis of cervical tuberculous lymphadenitis in children

BackgroundTo describe sonographic characteristics of cervical tuberculous lymphadenitis (CTBL) in children, clinical information, and sonograms of 348 lymph nodes (LNs) from 57 children with CTBL were retrospectively analyzed in this study.MethodsWe retrospectively reviewed the clinical data and sonograms of 348 LNs from 31 boys and 26 girls with CTBL, who were confirmed by pathology or laboratory examination, at the Hangzhou Red Cross Hospital between June 2014 and December 2020. The age of the children ranged from 1 to 14 years (average 7.1 ± 2.9 years).ResultsNight sweats, fatigue and loss of appetite were the most common clinical symptoms observed in children with CTBL. Unilateral LN involvements were common. Occasionally, CTBL was found in healthy children with no symptoms. On sonography, the hilus was absent or unclear in all LNs. The short-to-long axis (S/L) ratio was ≥ 0.5, and the edges were unclear in most LNs. Other accompanying findings included necrosis (47.4%), an echogenic thin layer (36.8%), surrounding soft-tissue edema (38.5%), multiple intra-nodal strong echo (28.2%), sinus (22.7%) and abscess formation (6.9%). The Doppler ultrasound showed that the majority of vascularity patterns of CTBL were capsular or peripheral (33.3%).ConclusionsUltrasound is a recommended examination method for children from different age groups with cervical lymphadenitis. The ultrasonic signs of hilus absence, S/L ratio ≥ 0.5, unclear edge, necrosis, echogenic thin layer, strong echoes and capsular or peripheral vascularity may aid in the diagnosis of cervical tuberculous lymphadenitis.

Performance of GeneXpert ultra in the diagnosis of Tuberculous Cervical lymphadenitis in formalin fixed paraffin embedded tissues

The diagnosis of Tuberculous Cervical lymphadenitis (TCL) is challenging. The present study aimed to assess the performance of GeneXpert ultra (GXu) in the diagnosis of TCL on Formalin Fixed, Paraffin Embedded Tissues (FFPET). This study included 35 TCL cases confirmed by positive microbiology and/or positive GXu on Fresh Tissues (FT). The diagnostic performance parameters of GXu on FFPET were determined with reference to microbiology (positive Ziehl Neelsen and/or positive culture) and with reference to positive microbiology and/or positive GXu on FT.The GXu on FFPET was positive in 26/35 (74%) cases. With reference to positive ZN and or culture, the sensitivity, specificity, positive predictive value, and negative predictive value of GXu on FFPET were 63%, 100%, 100% and 71% respectively. With reference to positive microbiology and/or positive GXu on FT, these rates were 74%, 100%, 100% and 40% respectively.GXu on FFPET is a reliable tool for the detection of Mycobacterium tuberculosis complex particularly for cases where microbiological investigations have not been performed.

CERVICAL TUBERCULOUS LYMPHADENITIS IN A CHILD: A CASE REPORT

Tuberculosis (TB) is an infectious disease primarily affecting the lungs, and the most common manifestation of extra-pulmonary tuberculosis is tuberculous lymphadenitis. A healthy 6-year-old female presented with a complaint of an asymptomatic swelling on the right side of her neck with gradual growth within 20 weeks. Extra-oral examination showed diffuse submandibular lymphadenopathy, erythematous aspect, painful and consistent under palpation and with central fluctuation. Intra-orally, the patient presented with multiple carious lesions. The patient’s CT showed a homogeneous, well-defined, hypodense mass in the submandibular region measuring 2.39 × 2.01 cm leading to the following hypotheses: dentoalveolar abscess, dermoid cyst, and pleomorphic adenoma. The patient was referred to a total lesion exeresis under general anesthesia. Histopathologic results showed lymphoid tissue presenting dense lymphocytes infiltrate, caseous necrosis, and giant multinucleated cells (Langhans type), leading to a final diagnosis of cervical tuberculous lymphadenitis. The patient was immediately transferred to start anti-TB treatment, undergo a chest radiography, and have an HIV test.

Role of contrast-enhanced ultrasound guidance in core-needle biopsy for diagnosis of cervical tuberculous lymphadenitis.

To investigate the diagnostic value of core-needle biopsy (CNB) guided by contrast-enhanced ultrasound (CEUS) in cervical tuberculous lymphadenitis (CTL). 178 patients with pathological confirmation of CTL were retrospectively enrolled. All of them had undergone CNB prior to the final surgery. According to the different ways of puncture guidance, they were divided into two groups: conventional ultrasound (US) group (n = 81) and CEUS group (n = 97). The comparison of diagnostic efficacy between two groups was compared and analyzed. Among the 178 patients, 146 were directly diagnosed as CTL by CNB, including 59 patients in CEUS group and 87 patients in US group. The diagnostic accuracy were 89.7% (87/97) and 72.8% (59/81), respectively (P < 0.01). For subgroup analyses, differences among diagnostic efficacy ascribed to the different guiding methods were significant in medium size group (>2.0 cm and ≤3.0 cm) and large size group (>3.0 cm), 91.7% for CEUS group vs. 69.0% for US group (P < 0.05) and 84.4% for CEUS group vs. 57.7% for US group (P < 0.05), respectively. In the diagnosis of CTL, compared with the US-guided CNB, CEUS-guided CNB have certain advantages, especially for larger lymph nodes.

Empirical treatment with non-anti-tuberculosis antibiotics decreased microbiological detection in cervical tuberculous lymphadenitis

Diagnosis of cervical tuberculous lymphadenitis (CTL), the most commonly occurring form of extrapulmonary tuberculosis, remains as a challenge in clinic. Detection of the presence of Mycobacterium tuberculosis (Mtb) in fine needle aspiration cytology (FNAC) samples is one golden criterion to confirm the CTL diagnosis. Due to the non-specific clinical presentation, CTL might be confused with other lymph node enlargement diseases; therefore empirical treatment with non-anti-TB antibiotics is often initially administered. However, it is still unclear whether this diagnostic antibiotic treatment affects the positivity of Mtb detection in FNAC. The demographics and clinical characteristics of 732 lymph node enlargement patients who had underwent FNAC were retrospectively analyzed and 605 (82.65%) of them were diagnosed as CTL. A total of 279 CTL cases (279/605, 46.11%) with completion of three Mtb tests (AFB, NAAT, and Mtb culture) in FNAC samples were selected for analyzing the effect of empirical antibiotic treatment on the positivity of Mtb tests. Compared to CTL patients without antibiotic treatment prior to FNAC, patients received empirical non anti-TB treatment had significantly lower positivity for acid fast bacilli staining (adjusted OR 0.11, 95% CI 0.06–0.21), nucleic acid amplification test (NAAT) (adjusted OR 0.38, 95% CI 0.21–0.71), and Mtb culture (adjusted OR 0.11, 95% CI 0.06–0.19). In conclusion, this study demonstrated that empirical non anti-TB antibiotic treatment reduced the opportunity to confirm CTL by microbiological analysis. Patients with cervical lymph node enlargement should undergo FNAC for Mtb tests prior to initiation of empirical non anti-TB treatment.

Efficacy of Fine-Needle Aspiration Cytology in the Diagnosis of Tuberculous Cervical Lymphadenitis

Objective: This study assesses the role of fine-needle aspiration cytology (FNAC) in the diagnosis of tuberculous lymphadenitis (TL) in comparison with histology and bacteriology findings. Study Design: We undertook a descriptive retrospective study of 937 FNAC specimens from 851 patients with cervical lymph nodes. The FNAC findings were then compared to histopathology and bacteriology. Results: Of the 937 aspirates, the cytopathological diagnoses consisted of 426 (55.9%) TL, 185 (24.3%) reactive lymphoid hyperplasia, 18 (2.3%) suppurative inflammation, 78 (10.2%) malignant metastatic tumor, and 54 (7%) lymphoma. Of the 426 TL cases, 171 were diagnosed by FNAC combined with bacteriological examination. In this group, 22 cases were found to be positive on Ziehl-Neelsen stain and 16 by culture. A histopathology report was available for 62 cases. Compared to histopathology, the overall diagnostic sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of FNAC in the diagnosis of cervical TL were, respectively, 96.77, 100, 100, and 96.67%. When comparing bacteriology to histopathology, these values were 97.44, 100, 100, and 91.67%. Conclusion: Our study shows that FNAC is a sensitive and specific tool for the diagnosis of cervical TL.

Role of chest X-ray in tuberculous cervical lymphadenitis

Tuberculous cervical lymphadenitis is not an uncommon entity when it comes to otolaryngology practice in Bangladesh. This study was done in the department of ENT and Head Neck Surgery, Dhaka Medical College Hospital, Dhaka, from January 2012 to January 2013 and was designed to find out chest x-ray abnormalities in apparently chest asymptomatic confirmed tuberculous cervical lymphadenitis without associated diseases. The diagnosis of tuberculous cervical lymphadenitis was confirmed by fine needle aspiration cytology (FNAC) and/or smear for acid-fast bacillus, and chest x-ray (PA view) was done in all confirmed cases (n=183). Normal chest x-ray was found in 132 cases (72.13%) and abnormal chest x-ray in 51 cases (27.87%). Pulmonary infiltration, the commonest radiological finding was detected in 32 cases (17.49%), hilar enlargement in 17 cases (9.29%), right paratracheal opacity in 2 (1.09%), obliteration of costophrenic angles in 3 cases (1.64%) and miliary mottling in one case (0.55%). Upper zonal predominance of lung parenchymal infiltrations was noted in 12.57% and right lung involvement in 16.39%. Single zone was affected in 9.84% cases and multiple zones were involved in 7.65% cases. We observed right hilar enlargement in 6.56%, left hilar lymphadenopathy in 4.37% and bilateral hilar lymphadenopathy in 2.73% cases. We concluded that routine chest x-ray should be done in all tuberculous lymphadenitis before categorization and starting of treatment. DOI: http://dx.doi.org/10.3329/jdmc.v22i2.21521 J Dhaka Medical College, Vol. 22, No.2, October, 2013, Page 125-128

A Clinical Study on Cervical Tuberculous Lymphadenitis

We retrospectively examined the records of patients treated for cervical tuberculous lymphadenitis in our department and analyzed the effectiveness of the various diagnostic methods. From January 2006 to December 2013, we treated 19 cases of cervical tuberculous lymphadenitis. The ages of patients with cervical tuberculous lymphadenitis ranged from 28 to 87 years old (mean, 61.4 years), and the male-to-female ratio was 8: 11. Two of the 19 patients with cervical tuberculous lymphadenitis presented with the comorbid condition of pulmonary tuberculosis. The sensitivity of cytological examination, smears, cultures and PCR (polymerase chain reaction) technique using an aspiration procedure for cervical tuberculous lymphadenitis were 13.3%, 50%, 60% and 71.4%, respectively: Although the detection ratio of fine needle aspiration cytology alone was low, the aspiration procedure could permit a definitive diagnosis by a combination of smear, culture and PCR. The QuantiFERON test (QFT) was positive in seven of seven cases, and T-SPOT was positive in two of two cases. Thus, QFT and T-SPOT were useful as aids in the diagnosis of cervical tuberculous lymphadenitis. For early diagnosis of cervical tuberculous lymphadenitis, it is important to consider a combined multimodal approach.

Ultrasonographic Features of Tuberculous Cervical Lymphadenitis

Making an accurate diagnosis of tuberculous cervical lymphadenitis (TCL) has been a problem to clinicians because it is a versatile masquerader and is often confused with lymphomas or cervical metastases. Ultrasound (US) has advantages over other examination modalities in that it is noninvasive, inexpensive, time-saving, and able to guide procedures such as fine-needle aspiration and core-needle biopsy. It is increasingly being recognized as a primary tool for the evaluation of cervical lymph nodes. In this article, we present six cases with microscopically and/or pathologically confirmed TCL and illustrate the US features. A literature review was also conducted. The key US features of TCL include hypoechogenecity, strong internal echoes, echogenic thin layers, nodal matting, soft tissue changes, and displaced hilar vascularity. US is a reliable and effective tool in assessing cervical lymphadenopathies. When TCL is suspected under US, US-guided procedures such as fine-needle aspiration or core-needle biopsy can be conducted concomitantly to obtain the microscopic or pathological proof.

Xpert MTB/RIF for diagnosis of tuberculous cervical lymphadenitis in HIV‐infected patients

The World Health Organization endorsed the Xpert MTB/RIF assay for the diagnosis of pulmonary tuberculosis (TB), but there is limited information about the utility of this assay for the diagnosis of TB lymphadenitis. Therefore, the objective of this study was to assess the diagnostic accuracy of Xpert MTB/RIF assay in HIV-infected patients with palpable cervical lymph nodes. Prospective, diagnostic test study. Consecutive patients with cervical lymphadenopathy were prospectively enrolled between January 2011 and March 2013. Lymph node specimens were obtained through fine-needle aspiration or excisional biopsy. Mycobacterial culture was considered as the gold standard. Mycobacterium TB was cultured from 15 of 68 specimens (22.05%), and 53 specimens had negative cultures (77.94%). The sensitivity of Xpert MTB/RIF was 100% (95% CI, 74.65%-100%), and the specificity was 100% (95% CI, 91.58%-100%). Smear microscopy had a lower diagnostic performance. Although based on a limited sample size, our study indicates that Xpert MTB/RIF is a useful method for the diagnosis of cervical TB lymphadenitis in HIV-infected patients, regardless of the bacillary load in smear-positive samples or the CD4 T cell count. The sensitivity, specificity, positive predictive value, and negative predictive value were similar to gold-standard culture. N/A.

English

The diagnosis of cervical tuberculous lymphadenitis has been performed by histological examination using excisional biopsy specimens. However a non-invasive diagnostic procedure alternative to invasive excisional biopsy has been required and fine needle aspiration cytology as well the polymerase chain reaction (PCR) techniques have become useful modalities. The aim of this study was to evaluate and compare different diagnostic modalities and establish their effectiveness in current conditions. We performed a retrospective study of two hundred patients of tuberculous cervical lymphadenitis admitted in the department of surgery, SAIMS Medical college and PG institute in a two year period from January 2011 to December 2012. Excision biopsy specimens and needle aspiration specimens were collected from all patients who were suspected as having cervical tuberculous lymphadenitis on the basis of clinical features, Mantoux test and other diagnostic techniques. The histopathological positive rates, the time period necessary for diagnosis, the rupture rate of the local skin lesion and the detection ratio of mycobacterium were compared between the two percutaneous approaches. The diagnosis of tuberculous lymphadenitis was successful in all cases either by cytological examination or with the histological approach. The sensitivity and the diagnostic efficacy of FNAC in detecting tubercular lymphadenitis were 87% and 80% respectively. The rupture rate of the local skin after the excisional biopsy was higher than that of the needle aspiration procedure . The time required for diagnosis was significantly longer than that of the needle aspiration procedure . Fine needle aspiration cytology is highly recommended as a less invasive method of diagnosis of cervical tuberculous lymphadenitis, but excision biopsy and histological examination is the gold standard.

Comparison of the Tuberculin Skin Test and the Interferon-γ Release Assay for the Diagnosis of Cervical Tuberculous Lymphadenitis

Received March 6, 2013 Revised April 15, 2013 Accepted April 22, 2013 Address for correspondence Jeong Kyu Kim, MD, PhD Department of OtolaryngologyHead and Neck Surgery, Catholic University of Daegu School of Medicine, 33 Duryugongwon-ro 17-gil, Nam-gu, Daegu 705-718, Korea Tel +82-53-650-4071 Fax +82-53-650-4533 E-mail doctorjkkim@cu.ac.kr Background and ObjectivesZZTo compare the tuberculin skin test (TST) and the interferon γ release assay (IGRA) for the diagnosis of cervical tuberculous lymphadenitis (TL). Subjects and MethodZZA prospective comparison between the TST and the IGRA was performed in subjects who met the inclusion criteria for suspicious cervical TL. TL was confirmed by culture results and clinical diagnosis of TL was also made by histology, polymerase chain reaction and treatment response of the anti-tuberculosis drug. ResultsZZOf the 43 subjects enrolled, 11 subjects were confirmed as TL, nine subjects as clinical TL and 23 subjects as non-TL. The TST and the IGRA were all positive in TL. The agreement between the TST and IGRA was κ=0.40 in both clinical TL and non-TL. The sensitivity and specificity of the TST were 95.0% [95% confidence interval (CI), 92.1-97.9] and 39.1% (95% CI, 32.6-45.6), respectively. By comparison, the sensitivity and specificity of the IGRA were 85.0% (95% CI, 80.3-89.8) and 52.2% (95% CI, 45.5-58.8), respectively. ConclusionZZThe IGRA was more specific than the TST, while the TST was more sensitive than the IGRA. The higher specificity of IGRA could make IGRA play a useful adjunct role in the diagnosis for cervical TL. Korean J Otorhinolaryngol-Head Neck Surg 2013;56:354-8

Factors that make it difficult to diagnose cervical tuberculous lymphadenitis

Cervical tuberculous lymphadenitis is mainly diagnosed by analyzing tissue samples obtained by fine-needle aspiration (FNA). However, some cases remain diagnostic challenges even after polymerase chain reaction analysis of FNA specimens. To delineate differences between cases that are relatively easy to diagnose and those for which diagnosis is difficult, 22 patients with cervical tuberculous lymphadenitis were studied retrospectively. FNA tissues were used to diagnose 14 cases (group A), whereas excisional biopsy was required for accurate diagnosis of 8 cases (group B). These two groups were compared with regard to results of blood examinations, ultrasound appearance, and various other procedures required to reach the final diagnosis. The results indicated that diagnosis of cervical tuberculous lymphadenitis was more difficult for patients with lower white blood cell counts, lower serum C-reactive protein levels, and absence of lymph node fusion or abscess formation on ultrasonography. The possibility of tuberculosis as a cause of cervical lymphadenopathy should always be considered, even when the presenting symptoms are not typical of this disease.