Is tuberculous lymphadenitis over-diagnosed in Ethiopia? Comparative performance of diagnostic tests for mycobacterial lymphadenitis in a high-burden country
Is tuberculous lymphadenitis over-diagnosed in Ethiopia? Comparative performance of diagnostic tests for mycobacterial lymphadenitis in a high-burden country
复制标题
DOI：
10.1080/00365540902897697
复制
发表时间：
2009-01-01
影响因子：
--
通讯作者：
Aseffa, Abraham
中科院分区：
文献类型：
--
作者：
Iwnetu, Rahel;Van Den Hombergh, Jan;Aseffa, Abraham
埃塞俄比亚报告的肺外结核病例数在全球排名第三，其中大多数是淋巴结结核（TBLN）。我们研究了TBLN的可用诊断测试的性能。细针穿刺（FNA）和切除活检样本从受影响的淋巴结收集了150例患者同意疑似TBLN访问埃塞俄比亚的地区医院。组织病理学检查的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为92%、88%、97%和77%，细针穿刺细胞学检查的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为76%、88%、100%和55%。肉眼检查FNA的敏感性为67%，特异性为64%。HIV合并感染不会降低肉眼检查、Ziehl-Neelsen染色、组织学或细胞学检查的性能。当ZN、组织病理学或培养的任何阳性结果被认为是确证性的时，85%的患者可以确认临床诊断，这表明TBLN在高达15%的病例中被过度诊断。以联合诊断标准为参考标准，FNAC诊断乳腺癌的敏感性为72%，特异性为100%，阳性预测值为100%，阴性预测值为55%。FNAC是一种实用的工具，可以提高TBLN在高负担环境中的诊断。过度诊断本身不能解释埃塞俄比亚LNTB的高负担。
Ethiopia reports the third highest number of extrapulmonary TB cases globally, most of which are lymph node TB (TBLN). We investigated the performance of the available diagnostic tests for TBLN. Fine needle aspirate (FNA) and excision biopsy samples from affected lymph nodes were collected from 150 consenting patients with suspected TBLN visiting regional hospitals in Ethiopia. The sensitivity, specificity, positive (PPV) and negative predictive value (NPV) of histopathology against culture as reference was 92%, 88%, 97% and 77% and of FNA cytology (FNAC) 76%, 88%, 100% and 55%, respectively. Naked eye examination of FNA had 67% sensitivity and 64% specificity. HIV coinfection did not diminish the performance of macroscopic examination, Ziehl-Neelsen stain, histology or cytology examinations. When any positive result in ZN, histopathology or culture was considered confirmatory, clinical diagnosis could be confirmed in 85% of the patients, suggesting that TBLN is over-diagnosed in up to 15% of cases. With combined criteria as reference standard, the sensitivity, specificity, PPV and NPV of FNAC was 72%, 100%, 100% and 55%, respectively. FNAC is a practical tool that can improve the diagnosis of TBLN in high-burden settings. Over-diagnosis alone cannot explain the high burden of LNTB in Ethiopia.