Correlation of Cytomorphology Pattern on FNAC with AFB Positivity in Tubercular Lymphadenitis Cases - Abstract
Background: Tuberculosis (TB) is common disease in developing countries. FNAC (fine needle aspiration cytology) is minimally invasive and inexpensive diagnostic procedure for evaluation of peripheral lymphadenopathy. Cytomorphological features and Ziehl Neelsen stains are used for confirmation of
tuberculosis on FNAC.
Aims: We aim to evaluate role of cytomorphological pattern in diagnosis of tubercular lymphadenitis (TBL).
Methods: Clinically suspected patients of TBL were sent for FNAC and included in study.
Results: FNAC was suggested TB in 90 patients. Out of 90 patients 63.3% were male and 36.7% female. Mean age of included patients was 27.8 ± 11.7 years. Mostly patients clinically presented with fever (24%). Cervical lymph nodes mostly affected in 60%. Cytomorphological findings suggestive of TB were grouped in following patterns with their percentage: Pattern 1: Epithelioid granulomas, Langerhans giant cells, caseous necrosis -25.6%, Pattern 2: Epithelioid granulomas with caseous necrosis - 15.7%, Pattern 3: Epithelioid granulomas, Langerhans giant cells, caseous necrosis, polymorphs- 16.6%. Pattern 4: Numerous clusters of epithelioid cells, granuloma, giant cells in a reactive background- 13.3%, Pattern 5: Granulomas, caseous necrosis, polymorphs- 12.2%. Pattern 6: Only caseous necrotic material - 10.0%, Pattern 7: Predominantly neutrophils, degenerating cells, semi fluid necrotic material- 6.6%. Overall AFB
positivity rate was 53.3%. Pattern 3 showed highest positivity (80%) for AFB, pattern 2 (64.4%), pattern 1 (60.8%). Pattern 3 was most specific (92.3%), pattern 6 and 7 (90.4% each).
Conclusion: FNAC is sensitive, specific and rapid procedure for diagnosis of TBL. Cytomorphological Pattern 3 was most specificity and pattern 1 sensitivity for diagnosis of TBL.