Utility of Fine Needle Aspiration Cytology (FNAC) in the diagnosis of tuberculous lymphadenitis compared to GeneXpert in a tertiary health care center in Northern Odisha, India.
Utility of Fine Needle Aspiration Cytology (FNAC) in the diagnosis of tuberculous lymphadenitis compared to GeneXpert in a tertiary health care center in Northern Odisha, India.
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DOI：
10.1016/j.ijtb.2021.01.005
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发表时间：
2021-10-01
期刊：
影响因子：
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通讯作者：
Dhangadamajhi, Gunanidhi
中科院分区：
文献类型：
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作者：
Gouda, Kalyani;Das, Upasana;Dhangadamajhi, Gunanidhi
背景技术背景：包括结核性淋巴结炎（TBLN）在内的肺外结核的诊断具有挑战性，因为其临床表现不典型，感染部位分枝杆菌的少菌性，不同方法和不同感染组织采集的标本的检测灵敏度不同。在本研究中，前瞻性地招募了疑似淋巴结结核的个体，无论年龄大小，并通过细针抽吸（FNA）无菌收集标本。在排除标准实施后，对278例疑似TBLN患者的FNA标本进行细胞形态学（FNAC）、涂片镜检抗酸杆菌（AFB）和基于琼脂糖凝胶的核酸扩增试验（CBNAAT）中分枝杆菌DNA特异性检测。结果表明，针吸活检中Ⅱ型占59.71%，其次为Ⅰ型（34.53%）和Ⅲ型（5.75%）。非II型模式在头颈部以外的区域显著较高（P=0.031; OR=2.125），并且随着年龄的增长其发生率有增加的趋势。受影响最大的年龄组为16 - 30岁，女性在45岁以下的个体中占优势，而男性在较高年龄组患者中占优势，其中大多数患者在HAN区域外感染淋巴结（P=0.063，OR=1.998）。结果还显示CBNAAT法（83.04%）和FNAC法（72.17%）具有较高的敏感性，AFB涂片显示出令人失望的结果（10.86%）相比，CRS。在III型（AFB：25% vs CBNAAT：100%）中观察到高阳性百分比，其次是II型（AFB：10.2 vs CBNAAT：76.5），而在I型样本中观察到低检出率（AFB：4.2 vs CBNAAT：50）。有趣的是，CBNAAT检测TB被证明是不受性别，年龄和部位infection.CONCLUSION：该研究表明，年龄和性别的TBLN细胞形态分布在不同的身体部位可能contributary作用。虽然FNAC在CBNAAT和/或AFB鉴定为阳性的病例中检出了77.1%的TB，但它仅基于细胞形态学，不能单独用作TBLN检测的可靠诊断方法。此外，FNAC阳性病例的CBNAAT阴性结果不一定是非结核病例，必须通过其他诊断方式进行评估。我们建议对疑似TBLN的细针抽吸物进行细胞形态学研究和CBNNAT，并进行后续治疗，以减少疾病负担。
BACKGROUND: Diagnosis of extrapulmonary tuberculosis including tuberculous lymphadenitis (TBLN) is challenging because of its atypical clinical presentation, paucibacillary nature of mycobacteria at the infected sites, variation in sensitivity of a test to specimens collected by different methods and from different infected tissues.METHODS: In the present study, suspected individuals for lymph node tuberculosis irrespective of age were enrolled prospectively and specimens were collected aseptically by fine needle aspiration (FNA). After the implementation of exclusion criteria, FNA specimens from a total of 278 cases of suspected TBLN were evaluated for cytomorphology (FNAC), presence of acid-fast bacillus (AFB) in smear microscopy and specific detection of mycobacterial DNA in cartridge-based nucleic acid amplification test (CBNAAT).RESULTS: The results showed high prevalence of Type II (59.71%), followed by Type I (34.53%) and Type III (5.75%) pattern in FNAC. Non-type II patterns were significantly high in regions outside of the head and neck region (P=0.031; OR=2.125) and had an increasing trend of their occurrences with progression of age. The most affected age group was between 16 and 30 years with female preponderance documented in individuals below 45 years, whereas male preponderance was observed in higher age group patients, majority of whom had infected lymph nodes outside of HAN region (P=0.063, OR=1.998). The results also showed high sensitivity of CBNAAT (83.04%) method followed by FNAC (72.17%) with AFB smear exhibiting the disappointing results (sensitivity of 10.86%) compared to the CRS. High percentage of positivity was observed in Type III (AFB:25% vs CBNAAT: 100%) followed by Type II (AFB:10.2 vs CBNAAT: 76.5), while low detection was observed from samples with Type I (AFB:4.2 vs CBNAAT: 50). Interestingly, CBNAAT detection of TB was shown to be unaffected by gender, age and site of infection.CONCLUSION: The study suggests a possible contributary role of age and gender for cytomorphological pattern distribution of TBLN at various body parts. Although FNAC detected TB in 77.1% of cases which were identified positive by CBNAAT and/or AFB, it is being solely based on cytomorphology cannot be used alone as a reliable diagnostic method for TBLN detection. Further, the negative results in CBNAAT for FNAC positive cases may not necessarily be non-TB cases and must be evaluated by other diagnostic modalities. We recommend for both cytomorphological investigation and CBNNAT for the fine needle aspirates from suspected TBLN and subsequent treatment to reduce the disease burden.