Division of Clinical Haematology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
AIDS. 2023 Mar 15;37(4):587-594. doi: 10.1097/QAD.0000000000003456. Epub 2022 Dec 6.
In tuberculosis (TB)-endemic areas, lymphadenopathy is frequently due to TB adenitis, but lymphoma and cancers are important differential diagnoses and critical to diagnose at the earliest opportunity. Key obstacles to lymphoma diagnosis include empiric TB treatment and difficulty accessing a biopsy. We report on a specialized clinic utilizing high-yield investigations for patients with lymphadenopathy.
This prospective interventional study investigated the utility of a core biopsy and the Xpert MTB/RIF Ultra (Ultra) on fine-needle aspirate (FNA) and tissue in a newly established lymph node biopsy clinic over 4 years. Electronic referral facilitated patient assessment within a week. Hematology fellows without specialist surgical or radiological expertise performed the biopsy on the first visit.
In 277 patients, including 43% people with HIV, TB was the most frequent diagnosis (34%), followed by lymphoma (27%) and other cancers (17%). Patients were seen a median of 5 days [interquartile range (IQR) 2-8.5 days] from referral. Core biopsy provided sufficient tissue for diagnosis in 96% of patients with lymphoma (72/75) and 94% of patients with cancer (44/47). FNA Ultra had a sensitivity of 73.9% [34/46; 95% confidence interval (CI) 58.9-85.7], and tissue Ultra 73% (46/63; 95% CI 60.3-83.4). There were six false-positive Ultra tests, highlighting the value of histology to either support TB or make an alternative diagnosis.
Core biopsies collected under the conditions described are safe and sensitive and can yield a rapid diagnosis. Combining Ultra and a core biopsy can accurately diagnose TB and cancer. This clinic provides an implementation model for resource-constrained and TB-endemic areas.
在结核病（TB）流行地区，淋巴结病常由结核性淋巴结炎引起，但淋巴瘤和癌症是重要的鉴别诊断，需要尽早诊断。淋巴瘤诊断的主要障碍包括经验性抗结核治疗和获取活检的困难。我们报告了一个专门的诊所，该诊所利用高产量的研究来为淋巴结病患者提供服务。
这项前瞻性干预研究调查了在一个新成立的淋巴结活检诊所中，核心活检和 Xpert MTB/RIF Ultra（Ultra）对细针抽吸（FNA）和组织的应用 4 年来的效果。电子转诊可在一周内对患者进行评估。没有专业手术或放射学专业知识的血液学研究员在首次就诊时进行活检。
在 277 名患者中，包括 43%的 HIV 患者，结核病是最常见的诊断（34%），其次是淋巴瘤（27%）和其他癌症（17%）。患者从转诊到就诊的中位数时间为 5 天[四分位间距（IQR）2-8.5 天]。核心活检在 96%的淋巴瘤（72/75）和 94%的癌症患者（44/47）中提供了足够的组织进行诊断。FNA Ultra 的敏感性为 73.9%[34/46；95%置信区间（CI）58.9-85.7]，组织 Ultra 的敏感性为 73%[46/63；95%CI 60.3-83.4]。有 6 次 Ultra 检测假阳性，这突显了组织学对支持结核病或做出其他诊断的重要性。
在描述的条件下收集的核心活检是安全和敏感的，可以快速做出诊断。结合 Ultra 和核心活检可以准确诊断结核病和癌症。该诊所为资源有限和结核病流行地区提供了实施模式。
