细菌学方法作为细针穿刺细胞学检查的附加检测用于诊断结核性淋巴结炎：它们能否减少诊断困境？
Bacteriological methods as add on tests to fine-needle aspiration cytology in diagnosis of tuberculous lymphadenitis: can they reduce the diagnostic dilemma?
作者信息
Abdissa Ketema, Tadesse Mulualem, Bezabih Mesele, Bekele Alemayehu, Apers Ludwig, Rigouts Leen, Abebe Gemeda
机构信息
Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia.
Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
出版信息
BMC Infect Dis. 2014 Dec 31;14:720. doi: 10.1186/s12879-014-0720-z.
BACKGROUND
The diagnostic accuracy of fine-needle aspiration (FNA) cytology for the diagnosis of tuberculous lymphadenitis (TBLN) is confounded by mimicking cytomorphologic disorders. The objective of this study was to determine whether supplementing FNA cytology with bacteriological methods improves the overall accuracy of TBLN diagnosis.
METHODS
Two hundred presumptive TBLN cases were included in the study. FNA specimens were collected and examined for cytomorphologic changes, for acid-fast bacilli (AFB) by microscopy and for mycobacterial growth on culture. Culture was done using Lowenstein-Jensen (LJ) medium and mycobacteria growth indicator tube (BACTEC MGIT 960 TB detection system). Differentiation between M. tuberculosis complex (MTBc) and non-tuberculous mycobacteria (NTM) was done by using 500 μg/ml para-nitrobenzoic acid (PNB) susceptibility testing.
RESULTS
Cytomorphology detected TBLN among 80% (160/200) of the presumptive cases. Culture results were available for 188 cases. Twelve samples were excluded due to contamination on both culture methods. Culture confirmed cases accounted for 78% (147/188) of which MTBc constituted 97.3% (143/147). Among presumptive cases, classified by FNA cytology as 'abscess', 11 were culture positive. Microscopy detected 31.3% (46/147) of culture confirmed mycobacterial lymphadenitis of which 11% (4/37) were diagnosed non-suggestive for tuberculosis (TB) by FNA cytology. Compared to culture (LJ & BACTEC MGIT 960) and AFB microscopy as composite gold standard, FNA cytology had a sensitivity of 88.4% and a specificity of 48.8%. The positive predictive value was 86.1% while the negative predictive value was 54.1%. The confirming power and the ROC curve area was 1.73 and 0.69, respectively.
CONCLUSION
FNA cytology showed a relatively high sensitivity but a low specificity. Combining bacteriological methods with FNA cytology in an endemic region like Ethiopia improves the overall accuracy of the diagnosis of mycobacterial lymphadenitis, which in turn may lead to better patient management.
背景
细针穿刺（FNA）细胞学检查对结核性淋巴结炎（TBLN）的诊断准确性受到类似细胞形态学紊乱的影响。本研究的目的是确定将细菌学方法与FNA细胞学检查相结合是否能提高TBLN诊断的总体准确性。
方法
本研究纳入了200例疑似TBLN病例。收集FNA标本，检查细胞形态学变化、通过显微镜检查抗酸杆菌（AFB）以及在培养基上检测分枝杆菌生长情况。使用罗-琴（LJ）培养基和分枝杆菌生长指示管（BACTEC MGIT 960结核检测系统）进行培养。通过使用500μg/ml对硝基苯甲酸（PNB）药敏试验来区分结核分枝杆菌复合群（MTBc）和非结核分枝杆菌（NTM）。
结果
细胞形态学在80%（160/200）的疑似病例中检测出TBLN。188例病例获得了培养结果。由于两种培养方法均受到污染，排除了12份样本。培养确诊病例占78%（147/188），其中MTBc占97.3%（143/147）。在FNA细胞学分类为“脓肿”的疑似病例中，11例培养呈阳性。显微镜检查在培养确诊的分枝杆菌性淋巴结炎中检测出31.3%（46/147），其中11%（4/37）通过FNA细胞学检查诊断为不支持结核病（TB）。与培养（LJ和BACTEC MGIT 960）及AFB显微镜检查作为复合金标准相比，FNA细胞学检查的敏感性为88.4%，特异性为48.8%。阳性预测值为86.1%，阴性预测值为54.1%。确诊能力和ROC曲线面积分别为1.73和0.69。
结论
FNA细胞学检查显示出相对较高的敏感性但较低的特异性。在埃塞俄比亚这样的流行地区，将细菌学方法与FNA细胞学检查相结合可提高分枝杆菌性淋巴结炎诊断的总体准确性，进而可能带来更好的患者管理。
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