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Comparison of fine-needle aspiration technique with Ziehl–Neelsen stains in diagnosis of tuberculous lymphadenitis

Jignasha M Patel, Kamini R Patel, Kamlesh Shah, Niraj U Patel, Hinal Baria, Prashant D Patel.


Background: Lymphadenopathy is one of the most common clinical presentation among patients. In developing countries such as India, tuberculous (TB) lymphadenitis is one of the common causes of lymphadenopathy. Cytomorphology with acid-fast staining is a valuable diagnostic tool in cases of tuberculosis.

Objective: To describe pattern of TB lymphadenitis presentation, and to compare results of fine needle aspiration cytology (FNAC) and Ziehl–Neelsen (ZN) stain in the diagnosis of TB lymphadenitis.

Materials and Methods: Total 351 patients of lymphadenopathy referred to the Department of Pathology, GMERS Medical College & Hospital, Vadodara, Gujarat, India, between March 2011 and December 2013included. FNAC was performed in all these patients and smears were prepared. Smears were stained with hematoxylin and eosin stain. ZN staining for acid-fast bacilli (AFB) was carried out on separate slide.

Results: Maximum number of patients (162; 46.15%) were from age group of 11–30 years. Total 351 cases [179 (50.99%) females and 172 (49.00%) males] were included in the study. Of 351 cases, 173 (49.28%) had tuberculosis, 141 (40.17%) had lymphadenitis other than tuberculosis, and 37 (10.54%) had malignant lymphadenopathy, including 2 (0.56%) cases of primary malignancy (i.e., lymphoma) and 35 (09.97%) of metastasis to lymph nodes. Overall, 119 (33.90%) cases were found to be positive for AFB on ZN staining.

Conclusion: FNAC is an optimally selected, efficient, easy to perform, and economical test for initial diagnostic workup in patients with TB lymphadenitis. Supplementation of ZN stain with FNAC increases the rates of diagnosis.

Key words: Tuberculosis, lymphadenopathy, fine-needle aspiration cytology, Ziehl-Neelsen stain

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