DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20203441

Correlation between cytomorphology and acid fast bacilli positivity in tubercular lymphadenopathy in far Western Nepal: a hospital based study

Ashok Shreepaili, Sushil Dhakal

Abstract


Background: Tuberculous lymphadenitis is the most common manifestation of extrapulmonary tuberculosis. Fine needle aspiration cytology (FNAC) is a valuable tool in diagnosis of tubercular lymphadenitis. The present study aims to determine the prevalence of different cytomorphological patterns in fine needle aspiration cytology of tubercular lymph nodes and their correlation with Acid Fast Bacilli (AFB) positivity on Ziehi-Neelsen (ZN) Staining.

Methods: Fine needle aspiration cytology of 274 cases diagnosed as tubercular lymphadenitis over a period of a year were reviewed. Cytomorphological patterns were categorized into three patterns. Pattern I: Epithelioid granuloma without necrosis, Pattern II: Epithelioid granuloma with caseous necrosis and Pattern III: Caseous necrosis only. Fischer Exact test was applied to correlate cytomorphological pattern and AFB positivity.

Results: Tuberculous lymphadenitis was most frequent in age group 21-30 years (24.81%). Cervical lymph nodes were the most frequent lymph nodes involved (84.67%). Pattern I was the most common cytomorphological pattern observed (49.3%). Overall AFB positivity was 28.10%. Maximum AFB positivity was seen in pattern III (73.3%).

Conclusions: FNAC is the simple, cost effective and minimally invasive tool to diagnose tuberculous lymphadenitis. Study of both cytomorphological pattern and ZN staining for AFB can improve the diagnostic accuracy.


Keywords


Acid fast bacilli, Cytomorphological pattern, Tuberculous lymphadenitis

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References


Nepal Annual Tuberculosis Report National Tuberculosis Programme; 2018.

Gupta P. Difficulties in managing lymph node tuberculosis. Lung India. 2004;21(4):50.

Handa U, Mundi I, Mohan S. Nodal tuberculosis revisited: a review. The J Infection Developing Countries. 2012;6(01):6-12.

Dukare S, Jadhav D, Gaikwad A, Ranka S, Kale P, D’costa G. Fine needle aspiration cytology of cervical lymphadenopathy-a study of 510 cases. Asian J Sci Technol. 2014;5(9):537-40.

Gupta SK, Chugh T, Sheikh Z, Al-Rubah N. Cytodiagnosis of tuberculous lymphadenitis. A correlative study with microbiologic examination. Acta cytologica. 1993;37(3):329-32.

Chiedozi L, Kollur S. Fine needle aspiration cytology of head and neck masses. Seven years' experience in a secondary care hospital. Acta cytologica. 2003;47(3):387-92.

7. Nur TE, Shirin A, Saha MM. Diagnostic Accuracy of Fine Needle Aspiration Cytology in Diagnosis of Tuberculous Lymphadenitis. J Enam Medical College. 2019;9(1):30-3.

Chakrabarti AK, Halder KK, Das S, Chakrabarti S. Morphological classification of tuberculous lesions: preliminary observations. Ind J Tub. 1994;41:139-42.

Laishram RS, Devi R, Konjengbam R, Devi R, Sharma L. Aspiration cytology for the diagnosis of tuberculous lymphadenopathies: A five-year study. J Indian Acad Clin Med. 2010;11:31-5.

Afrose R, Singh N, Bhatia A, Arora VK. Cytomorphological tissue reaction patterns in lymph node tuberculosis and their correlation with bacterial density. Annals Trop Med Pub Heal. 2014;7(6):255.

Mohapatra PR, Janmeja AK. Tuberculous lymphadenitis. J Assoc Physicians India. 2009;57(6):585-90.

Bhatta S, Singh S, Chalise SR. Cytopathological patterns of tuberculous lymphadenitis: an analysis of 126 cases in a tertiary care hospital. Inter J Res Med Sci. 2018;6(6):1898.

Hemalatha A, Shruti P, Kumar MU, Bhaskaran A. Cytomorphological patterns of tubercular lymphadenitis revisited. Annals Medical Heal Sci Res. 2014;4(3):393-6.

Patel H, Patel K, Bhalodia J. Fine-needle Aspiration Cytology in Tuberculous Lymphadenitis: A Study of 200 Cases of Superficial Lymphadenopathy.

Bezabih M, Mariam D, Selassie S. Fine needle aspiration cytology of suspected tuberculous lymphadenitis. Cytopathology: official J British Society for Clin Cytol. 2002;13(5):284-90.

Masilamani S, Arul P, Akshatha C. Correlation of cytomorphological patterns and acid-fast Bacilli positivity in tuberculous lymphadenitis in a rural population of southern India. J Natural Science, Biol. Med. 2015;6(Suppl 1):S134.

Vimal S, Dharwadkar A, Chandanwale SS, Vishwanathan V, Kumar H. Cytomorphological study of lymph node lesions: A study of 187 cases. Medical J Dr DY Patil University. 2016;9(1):43.

Jagtap S, Jagtap S, Aher V. Fine needle aspiration cytology in diagnosis of lymphadenopathy associated with tuberculosis. J Evidence Based Medicine Healthcare. 2015;2:8127-30.

Narayanamurthy C, CR KS. Study of cytological pattern of tubercular lymphadenitis. Global J Medical Res. 2012;12(1).

Nidhi P, Sapna T, Shalini M, Kumud G. FNAC in tuberculous lymphadenitis: Experience from a tertiary level referral centre. Indian J Tuberc. 2011;58(3):102-7.

Das D, Pant J, Chachra K, Murthy N, Satyanarayan L, Thankamma T, et al. Tuberculous lymphadenitis: correlation of cellular components and necrosis in lymph-node aspirate with AFB positivity and bacillary count. Indian J Pathol & Microbiol. 1990;33(1):1-10.