Gupta Vivek, Bhake Arvind
Department of Pathology, Jawaharlal Nehru Medical College Sawangi, Wardha, India.
Acta Cytol. 2017;61(3):173-178. doi: 10.1159/000475832. Epub 2017 May 20.
The diagnosis of peripheral tubercular lymphadenopathy (TBLN) in pediatric patients is often a challenge because features evident on fine-needle aspiration cytology (FNAC) or tissue biopsy can be deceptive for the reason that they result from an immunological response. This study aimed to evaluate polymerase chain reaction (PCR) for Mycobacterium tuberculosis complex (MTBC) in pediatric patients under clinical suspicion for TBLN and to assess its role in the evaluation of cases cytodiagnosed as reactive lymphoid hyperplasia.
This was a cross-sectional study conducted on 45 pediatric patients clinically suspected and unsuspected for TBLN. FNAC, culture on Löwenstein-Jensen medium, and real-time PCR were performed. Comparative values with reference to the culture were calculated.
Cytology had a sensitivity and specificity of 38.5 and 87.5%, respectively. Real-time PCR had a sensitivity and specificity of 84.6 and 81.3%, respectively. Of the 32 cases with a cytodiagnosis of reactive lymphoid hyperplasia, 53% were positive both on PCR and culture for M. tuberculosis; the φ value of 0.93 demonstrated a strong association between these 2 methods.
Real-time PCR is useful in detecting MTBC in pediatric patients, and it also helps in the diagnosis of cases missed on FNAC.
小儿外周结核性淋巴结病（TBLN）的诊断往往具有挑战性，因为细针穿刺细胞学检查（FNAC）或组织活检所显示的特征可能具有欺骗性，这是由免疫反应导致的。本研究旨在评估聚合酶链反应（PCR）在临床怀疑患有TBLN的小儿患者中检测结核分枝杆菌复合群（MTBC）的情况，并评估其在评估细胞诊断为反应性淋巴样增生病例中的作用。
这是一项对45例临床怀疑和未怀疑患有TBLN的小儿患者进行的横断面研究。进行了FNAC、罗氏培养基培养和实时PCR检测。计算了与培养结果相比的相关值。
细胞学检查的敏感性和特异性分别为38.5%和87.5%。实时PCR的敏感性和特异性分别为84.6%和81.3%。在32例细胞诊断为反应性淋巴样增生的病例中，53%的病例结核分枝杆菌PCR和培养均为阳性；0.93的φ值表明这两种方法之间存在强关联。
实时PCR有助于检测小儿患者中的MTBC，也有助于诊断FNAC漏诊的病例。
