Nidhi Paliwal, Sapna Thakur, Shalini Mullick, Kumud Gupta
Department of Pathology, LRS Institute of TB & Respiratory Diseases, New Delhi.
Indian J Tuberc. 2011 Jul;58(3):102-7.
In developing countries like India, tuberculous lymphadenitis is one of the most common causes of lymphadenopathy. However, anti-tubercular treatment cannot be given only on clinical suspicion. Cytomorphology with acid fast staining proves to be a valuable tool in diagnosing these cases.
To study the utility, limitations of fine needle aspiration cytology and various cytomorphological presentations in reference to Ziehl-Neelsen staining in tuberculous lymphadenitis.
In a study period of July to October 2010, three hundred and eighteen consecutive superficial lymph nodes, clinically suspected to be tuberculous were subjected to cytological evaluation with Hematoxylin & Eosin, Giemsa and Ziehl-Neelsen stained smears. In addition, demographic profile of these patients with clinical presentation was also studied.
Incidence of tuberculous lymphadenitis was 55%. Overall AFB positivity was 71.0%. Only Necrosis without epithelioid cell granulomas was the most common cytological picture and that showed highest AFB positivity also. Three-fourth of the patients presented in second to fourth decade of life. Cervical region was the most common site of involvement with solitary lymphadenopathy as the most common presentation in contrast to matted lymph nodes as reported by others.
Fine needle aspiration cytology is a safe, cheap procedure requiring minimal instrumentation 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. Microbiological assessment should also be done in such cases.
在印度等发展中国家，结核性淋巴结炎是淋巴结病最常见的病因之一。然而，不能仅凭临床怀疑就进行抗结核治疗。抗酸染色的细胞形态学被证明是诊断这些病例的重要工具。
研究细针穿刺细胞学检查在结核性淋巴结炎中的应用、局限性以及与齐-尼氏染色相关的各种细胞形态学表现。
在2010年7月至10月的研究期间，对318例临床怀疑为结核的连续性浅表淋巴结进行了苏木精-伊红染色、吉姆萨染色和齐-尼氏染色涂片的细胞学评估。此外，还研究了这些有临床表现患者的人口统计学特征。
结核性淋巴结炎的发病率为55%。总体抗酸杆菌阳性率为71.0%。仅见坏死而无上皮样细胞肉芽肿是最常见的细胞形态学表现，且其抗酸杆菌阳性率也最高。四分之三的患者年龄在第二个十年到第四个十年。颈部是最常受累的部位，最常见的表现为孤立性淋巴结病，这与其他人报道的融合性淋巴结病形成对比。
细针穿刺细胞学检查是一种安全、廉价的检查方法，所需设备最少，对诊断结核性淋巴结炎高度敏感。通过抗酸染色补充细胞形态学可进一步提高敏感性。在抗酸染色阴性的病例中，通过对第二次涂片或显示坏死的脱色涂片进行齐-尼氏染色或重复穿刺，可提高抗酸杆菌阳性率。此类病例也应进行微生物学评估。
