Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Avenida de Córdoba S/N, 28048, Madrid, Spain.
Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain.
Eur J Pediatr. 2021 Apr;180(4):1279-1286. doi: 10.1007/s00431-020-03875-2. Epub 2020 Nov 17.
Nontuberculous mycobacterial lymphadenitis often presents a diagnostic challenge. This study aimed to evaluate the role of fine-needle aspiration cytology in the diagnosis of nontuberculous mycobacterial lymphadenitis in children. We conducted a retrospective review of fine-needle aspiration cytology performed in patients < 17 year-old with subacute lymphadenitis from 2003 to 2016 in a tertiary hospital in Spain. Confirmed nontuberculous mycobacterial lymphadenitis (isolation of nontuberculous mycobacterial in culture from fine-needle aspiration cytology or biopsy samples) and probable nontuberculous mycobacterial lymphadenitis ("granulomatous inflammation" in cytopathologic examinations from fine-needle aspiration cytology or biopsy and clinical-epidemiological history compatible with nontuberculous mycobacterial) were selected. Forty-one patients with nontuberculous mycobacterial lymphadenitis were included: 14 confirmed and 27 probable. Fine-needle aspiration cytology was done in all of them. For 34 patients with excised lymphadenopathy, cytopathology from fine-needle aspiration cytology was concordant with biopsy in 100% cases. Culture results were available from 78.0% (32/41) of patients with fine-needle aspiration cytology and from 85.3% (29/34) with excisional biopsy. Among 22 patients with microbiological results from fine-needle aspiration cytology and biopsy, fine-needle aspiration cytology allowed advanced results in concordance with biopsy or with positive isolation not found in biopsy in 90.1% (20/22) of patients. Sensitivity of nontuberculous mycobacterial cultures obtained by fine-needle aspiration cytology compared to biopsy was 45.5% vs. 36.4% (p = 0.07). Two patients with previous skin alterations presented fistulas after fine-needle aspiration cytology (4.9%); no other complications were described.Conclusion: Fine-needle aspiration cytology provides quick cytopathologic information and is an accurate and safe technique for the diagnosis of nontuberculous mycobacterial lymphadenitis, especially in cases with challenging work-up. What is Known: • Nontuberculous mycobacterial (NTM) infection is an important cause of subacute lymphadenitis in children. • Fine-needle aspiration cytology (FNAC) is an available technique for the diagnosis of lymphadenitis of unknown etiology. What is New: • FNAC is an accurate and safe technique for the diagnosis of NTM lymphadenitis in children. • FNAC can provide reliable samples for cytopathological studies and even a better sensitivity for microbiological culture than excisional biopsy in the study of suspected NTM lymphadenitis.
非结核分枝杆菌性淋巴结炎常常带来诊断挑战。本研究旨在评估细针穿刺细胞学检查在儿童非结核分枝杆菌性淋巴结炎诊断中的作用。我们对 2003 年至 2016 年期间西班牙一家三级医院就诊的 17 岁以下亚急性淋巴结炎患者进行了细针穿刺细胞学检查。确诊非结核分枝杆菌性淋巴结炎（从细针穿刺细胞学或活检样本中分离出非结核分枝杆菌）和可能的非结核分枝杆菌性淋巴结炎（细针穿刺细胞学或活检的细胞学检查中“肉芽肿性炎症”和与非结核分枝杆菌一致的临床流行病学史）。共纳入 41 例非结核分枝杆菌性淋巴结炎患者：14 例确诊，27 例可能。所有患者均行细针穿刺细胞学检查。对于 34 例有切除淋巴结病的患者，细针穿刺细胞学检查的细胞学检查与活检在 100%的病例中一致。78.0%（41/53）的细针穿刺细胞学患者和 85.3%（34/39）的切除活检患者有培养结果。在 22 例有细针穿刺细胞学和活检微生物学结果的患者中，90.1%（22/24）的患者细针穿刺细胞学检查可获得与活检一致或在活检中未发现阳性分离的高级结果。细针穿刺细胞学检查获得的非结核分枝杆菌培养的敏感性与活检相比为 45.5%比 36.4%（p=0.07）。2 例有皮肤改变既往史的患者在细针穿刺细胞学检查后出现瘘管（4.9%）；无其他并发症描述。结论：细针穿刺细胞学检查可快速提供细胞病理学信息，是一种准确、安全的技术，可用于诊断非结核分枝杆菌性淋巴结炎，尤其是在检查具有挑战性的情况下。已知：•非结核分枝杆菌（NTM）感染是儿童亚急性淋巴结炎的一个重要原因。•细针穿刺细胞学检查（FNAC）是一种用于诊断病因不明的淋巴结炎的可用技术。新内容：•FNAC 是一种准确、安全的技术，可用于诊断儿童 NTM 淋巴结炎。•在疑似 NTM 淋巴结炎的研究中，FNAC 可为细胞病理学研究提供可靠的样本，甚至比切除活检具有更高的微生物培养敏感性。
