Title: Evaluation of the Role of Fnac in Diagnosis of Tubercular Lympadenitis in Rural Setup in India
Author(s): Sharma S, Rana R
Address for Correspondance: Dr Shalini ,
Dept. of Pathology, Cure Surgical Hospital and Research Center, Solan, H.P., India.
Background: Tuberculous Lymphadenitis is one of the most common causes of lymph node enlargement in developing countries like India. However, anti-tubercular treatment cannot be given only on clinical suspicion. FNAC with special staining like AFB/ ZN staining proves to be an important , rapid and efficient diagnostic tool in diagnosing Tuberculous Lymphadenitis.
Aim: To study the utility of FNAC with Ziehl-Neelsen staining in diagnosis of tuberculous lymphadenitis.
Material and Methods: In a study period of one year, two hundred consecutive superficial lymph nodes, clinically suspected to be tuberculous were subjected to cytological evaluation with Hematoxylin & Eosin, Giemsa and Ziehl-Neelsen stained smears.
Results: Incidence of tuberculous lymphadenitis was 66%. Overall AFB positivity was 74.0%. Only Necrosis without epithelioid cell granulomas was the most common cytological picture and that showed highest AFB positivity also. 80% of the patients presented in second to fourth decade of life. Cervical region was the most common site of involvement with matted lymph nodes as the most common presentation in tubercular lymphadenitis.
Conclusions: Fine needle aspiration cytology is a reliable, safe and economical procedure requiring minimal intervention and is highly sensitive to diagnose tuberculous lymphadenitis. The sensitivity can be further increased by complementing cytomorphology with acid fast staining. In acid fast staining negative cases, yield of acid fast bacilli positivity can be increased by doing Ziehl-Neelsen staining on second smear or decolourized smear revealing necrosis or by repeat aspiration.