Annam Vamseedhar, Kulkarni Mohan H, Puranik Rekha B
Department of Pathology, Sree Siddhartha Medical College & Research Center, Tumkur, India.
Cytojournal. 2009 Jul 18;6:13. doi: 10.4103/1742-6413.53887.
The objectives were to correlate the modified fluorescent method with the conventional Ziehl-Neelsen (ZN) method for the detection of acid-fast bacilli (AFB) and, also to study the efficacy and advantages of using the auramine-rhodamine stain on lymph node aspirates under fluorescent microscopy.
In 108 consecutive patients with a clinical suspicion of tuberculosis (TB) presenting with lymphadenopathy, fine needle aspirations were performed. Smears from the aspirates were processed for routine cytology, the conventional ZN method, and the modified fluorescent method. The significance of the modified fluorescent method over the conventional ZN method was analyzed using the chi-square test.
Out of 108 aspirates, 102 were studied and remaining 6 were excluded from the study due to diagnosis of malignancy in 4.04% (4/6) and inadequate aspiration in 2.02% (2/6). Among the 102 aspirates, 44.11% (45/102) were positive for AFB on the conventional ZN method, 58.9% (60/102) were indicative of TB on cytology, while the smear positive increased to 81.37% (83/102) on the modified fluorescent method.
Fluorescent microscopy has the advantage of speed and ease of screening, and reduces observer fatigue. The modified fluorescent method was found to be more advantageous than routine cytology and conventional ZN method, particularly in paucibacillary cases. The bacillary positivity rates were higher in the modified fluorescent method than in the ZN method. Hence, the modified fluorescent method can be an adjuvant when used with routine cytology for the identification of AFB.
本研究旨在将改良荧光法与传统萋-尼(ZN)法用于检测抗酸杆菌(AFB)进行相关性分析,并研究在荧光显微镜下使用金胺-罗丹明染色对淋巴结穿刺液的检测效果及优势。
对108例临床怀疑患有结核病(TB)且伴有淋巴结肿大的连续患者进行细针穿刺抽吸。对穿刺液涂片进行常规细胞学检查、传统ZN法和改良荧光法检测。采用卡方检验分析改良荧光法相对于传统ZN法的意义。
108例穿刺液中,102例纳入研究,其余6例因4.04%(4/6)诊断为恶性肿瘤和2.02%(2/6)穿刺不足而被排除。在102例穿刺液中,传统ZN法检测AFB阳性率为44.11%(45/102),细胞学检查提示TB的比例为58.9%(60/102),而改良荧光法涂片阳性率增至81.37%(83/102)。
荧光显微镜检查具有筛查速度快、操作简便的优点,且能减少观察者疲劳。改良荧光法比常规细胞学检查和传统ZN法更具优势,尤其是在菌量少的病例中。改良荧光法的杆菌阳性率高于ZN法。因此,改良荧光法与常规细胞学检查联合使用时,可作为鉴定AFB的辅助方法。