Cytoponction ganglionnaire cervicale : facteurs influençant le taux d’échec

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

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.

Tuberculosis in the Head and Neck: Changing Trends and Age-Related Patterns

OBJECTIVE

To evaluate changing trends in patient collectives, age-related patterns of manifestation, and diagnostic pathways of patients with extrapulmonary head and neck tuberculosis (TB), and to provide strategies to fasten diagnosis in these patients.

STUDY DESIGN

Case control study.

METHODS

A 10-year retrospective analysis of 35 patients diagnosed with extrapulmonary TB in the head and neck at a tertiary university institution from 2009 to 2019, with special focus on the influence of the patient's age on consideration of TB and clinical patterns.

RESULTS

The vast majority of patients younger than 40 years had their origin in countries with high TB burden (P = .0003), and TB was considered very early as a differential diagnosis (P = .0068), while most patients older than 40 years were domestic citizens initially suspected for a malignancy, who more often had an underlying immunosuppressive condition (0.0472). Most frequent manifestations in both groups were the lymph nodes, larynx, and oropharynx. Surprisingly, no differences in the rates of open TB or history of TB infection in the family anamnesis were found.

CONCLUSION

The two groups of patients found most often are younger patients migrating from regions with high TB burden and elderly domestic patients suffering from immunosuppressive conditions, with the latter often being misdiagnosed as malignancies. TB remains an important but difficult differential diagnosis, due to the initially unspecific symptoms and the great variety in the presentation of manifestations in the head and neck.

LEVEL OF EVIDENCE

4 "case-control study" Laryngoscope, 2021.

Accuracy of fine-needle aspiration cytology of head and neck masses

BACKGROUND

Head and neck masses are a common presentation in daily practice and can be challenging to both clinicians and cytopathologists. Fine needle aspiration cytology (FNAC) is a widely used method for the diagnosis of head and neck masses. The aim of the study was to assess our institutional experience of the accuracy of FNAC in the diagnosis of head and neck masses.

METHODS

A total of 1262 FNACs were conducted from January 2013 to December 2016 and subdivided into benign and malignant categories. The thyroid and salivary glands FNACs were classified according to the Bethesda System for Reporting Thyroid cytopathology and to the Milan System for Reporting Salivary Gland Cytopathology respectively. The measures of diagnostic accuracy of FNAC were determined taking histology as a gold standard.

RESULTS

A total of 7 false negative (FN) and 6 false positive (FP) FNACs were identified. Overall sensitivity and specificity of FNAC for a malignant diagnosis were 92% and 94.4%, respectively. Accuracy of FNACs of head and neck masses was 93.5% for all sites. The salivary gland group had the highest rate of FN (2.8%). All FP were reported in the thyroid group. These cases were cytologically classified suspicious for malignancy (n = 3) and papillary carcinoma (n = 3) and proved to be lymphocytic thyroiditis on final histology. Among the most common locations, cytology of lymph nodes provided the best sensitivity (98.2%). Salivary glands as well as lymph nodes had the best specificity (100%).

CONCLUSION

FNAC of head and neck masses has a high accuracy allowing a correct therapeutic management. However, this accuracy depends on the anatomic location of the mass.

Fine needle non-aspiration cytology for the diagnosis of cervical lymph node tuberculosis: a single center experience

Introduction

The fine-needle cytology is being used as a first line of investigation in the diagnosis of head and neck swellings, as it is simple, cost effective and less invasive as compared to biopsy.

Objective

The aims of this study were to evaluate the results of the fine-needle non-aspiration cytology of cervical lymphadenopathy and to study the factors influencing the rate of non-diagnosis results.

Methods

This retrospective study was conducted on selected patients with cervical lymphadenopathy that had undergone a fine-needle non-aspiration cytology followed by a histological biopsy. The sensitivity, specificity, positive predictive value and negative predictive value of fine-needle non-aspiration cytology for diagnosing tuberculosis were estimated. The risk factors of non-diagnosis results were evaluated.

Results

The sensitivity, specificity, positive predictive value rates of fine-needle non-aspiration cytology for tuberculosis were 83.3%, 83.3%, 78.9% and 86.9% respectively. In total, 47 out of the 131 samples (35.8%) were considered non-diagnosis. Of the non-diagnosis samples, 84.2% (38 out of 47) were benign mostly due to tuberculosis (30 cases). Among the studied factors, only tuberculosis (confirmed by histopathological examination) was significantly associated with non-diagnosis cytology (p = 0.02, Odds-Ratio = 2.35).

Conclusion

Tuberculosis is currently the commonest cause of cervical lymphadenopathy in North Africa. Fine-needle non-aspiration cytology is safe and accurate in the diagnosis of cervical tuberculous lymph node that is associated with the risk of non-diagnosis cytology.