Sarkar Saurav, Sil Abheek, Sarkar Soma, Sikder Biswajit
Department of Otorhinolaryngology-Head and Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar 751019, India.
Ear Nose Throat J. 2017 Jun;96(6):E29-E32. doi: 10.1177/014556131709600606.
In recurrent tonsillitis, the pathogenic bacteria are harbored in the tonsil core, and therefore cultures of superficial swab samples are not particularly accurate in identifying specific types of core bacteria. On the other hand, the results of fine-needle aspiration (FNA) cultures of core samples have been closely correlated with the findings of core cultures in excised tonsils, and both methods are far superior to surface swabbing. We conducted a prospective study to compare the accuracy of culture findings from tonsillar tissue obtained by surface swabbing, FNA sampling of the tonsil core in situ, and core sampling of the excised tonsil in children with recurrent tonsillitis. Our patient population was made up of 54 children-22 boys and 32 girls, aged 4 to 14 years (mean: 10.7)-who were undergoing elective tonsillectomy during a 1-year period. On the day of surgery, a surface swab, core FNA sample, and dissected core sample were obtained from each patient and sent for culture. Culture showed that the three methods were in agreement in 34 cases (63.0%). In 9 cases (16.7%) the surface swab culture grew different pathogens from those of the two core cultures, and in 3 other cases (5.6%) the surface swab culture was negative while the two core cultures were positive for the same pathogens. In all, the results of core FNA culture and dissected core culture were in agreement in 46 cases (85.2%); in only 4 cases (7.4%) did the core FNA culture fail to accurately identify the causative pathogens. Overall, the sensitivity and specificity of core FNA sampling were 100 and 50% respectively, compared with 82.9 and 30.8% for the superficial tonsillar swab. We conclude that routine culture of surface swab specimens in patients with chronic or recurrent tonsillitis is neither reliable nor valid. We recommend that core FNA sampling be considered the diagnostic method of choice since it can be done on an outpatient basis, it would reliably allow for culture-directed antibiotic therapy, and it could obviate the need for elective tonsillectomy in many cases. However, its feasibility as an office procedure in children remains to be determined.
在复发性扁桃体炎中，病原菌寄居于扁桃体核心部位，因此，对扁桃体表面拭子样本进行培养，在识别核心部位特定类型细菌方面并不特别准确。另一方面，对核心样本进行细针穿刺抽吸（FNA）培养的结果，与切除扁桃体的核心组织培养结果密切相关，且这两种方法都远优于表面拭子采样。我们进行了一项前瞻性研究，以比较在复发性扁桃体炎患儿中，通过表面拭子采样、扁桃体核心原位FNA采样以及切除扁桃体的核心组织采样所获得的培养结果的准确性。我们的患者群体由54名儿童组成，其中22名男孩和32名女孩，年龄在4至14岁之间（平均年龄：10.7岁），他们在1年的时间里接受了择期扁桃体切除术。在手术当天，从每位患者身上获取表面拭子、核心FNA样本和切除的核心组织样本，并送去进行培养。培养结果显示，三种方法在34例（63.0%）中结果一致。在9例（16.7%）中，表面拭子培养出的病原菌与两种核心组织培养结果不同，在另外3例（占5.6%）中，表面拭子培养结果为阴性，而两种核心组织培养对相同病原菌呈阳性。总体而言，核心FNA培养和切除核心组织培养结果在46例（85.2%）中一致；仅在4例（7.4%）中，核心FNA培养未能准确识别致病病原菌。总体而言，核心FNA采样的敏感性和特异性分别为100%和50%，而扁桃体表面拭子采样的敏感性和特异性分别为82.9%和30.8%。我们得出结论，慢性或复发性扁桃体炎患者表面拭子样本的常规培养既不可靠也无效。我们建议将核心FNA采样视为首选诊断方法，因为它可以在门诊进行，能够可靠地实现针对培养结果的抗生素治疗，并且在许多情况下可以避免进行择期扁桃体切除术。然而，其作为儿童门诊操作的可行性仍有待确定。
