Abstract:Fine needle aspiration cytology in childhood TB lymphadenitis

J. Balaji1, 2 , S. Shanmuga Sundaram1, S. Nataraja Rathinam1, P. Amutha Rajeswari1 and M. L. Vasantha Kumari1

(1) Institute of Child Health and Research Centre, Government Rajaji Hospital and Madurai Medical College, Madurai, Tamil Nadu, India
(2) ADE / TNEB, Mullai Nagar, Periyampatty Post, Dharmapuri Dt Tamil Nadu., 635205, India
Received: 26 November 2008 Accepted: 28 May 2009 Published online: 20 November 2009

Objective To evaluate the efficacy of Fine Needle Aspiration Cytology (FNAC) to diagnose Tuberculous (TB) lymphadenitis with compare to excision biopsy and to correlate TB lymphadenitis with clinical, cytological, radiological and mantoux test features.
Methods This was a prospective correlational study. FNAC was done by a pediatrician for 135 children with persisting lymphadenitis after two weeks of antibiotic therapy in the period of January 2005 to June 2006 and compared with excision biopsy in a tertiary care hospital.
Results Forty Six cases (34.07%) were TB lymphadenitis diagnosed by FNAC. Excision biopsy and cytological correlation was done in 100 cases. Sensitivity, specificity and diagnostic accuracy for TB lymphadenitis were found to be 98%, 100% and 99% respectively. Positive and negative predictive values were 100 and 98 respectively. Large (>2cm) (86.9%), multiple (52.1%), matted (47.8%), posterior cervical and submandibular group nodes with history of contact (P=0.0016), positive mantoux test (P=0.0001) and Grade III and IV Protein Energy Malnutrition (PEM) (P=0.0041) were significantly seen in TB lymphadenitis. Ziehl Neelson staining for Acid Fast Bacilli (AFB) was positive in 32.5% cases of TB Lymphadenitis.
Conclusion Pediatrician himself can do FNAC which is an excellent first line method to diagnose TB lymphadenitis and it has equal accuracy to excision biopsy.