The value of wide-needle aspiration in the diagnosis of tuberculous lymphadenitis in Africa.

OBJECTIVES

To evaluate wide-needle (19-gauge) aspiration in the diagnosis of tuberculous lymphadenitis.

SETTING

Department of Surgery, University Teaching Hospital, Lusaka, Zambia.

PATIENTS

Three hundred and four patients presenting to one surgeon for diagnostic surgical biopsy of a peripheral lymph node during 1989-1990.

DESIGN

Prospective study in which wide-needle aspiration routinely preceded open surgical biopsy.

MAIN OUTCOME MEASURES

Histology and mycobacterial culture of the surgically biopsied lymph node; HIV-1 serology; successful aspiration of material, naked-eye appearance of aspirate, presence of acid-fast bacilli and/or microscopic caseation in the aspirate.

RESULTS

One hundred and eighty-eight out of 304 (61.8%) patients had histologically and/or culture-proven tuberculous lymphadenitis, of whom 155 out of 183 (84.7%) tested HIV-1-seropositive. Material was successfully aspirated from 180 out of 188 (95.7%) of patients with proven tuberculous lymphadenitis. Macroscopic caseation, diagnosable on naked-eye examination alone of the aspirate, was present in 49 out of 120 (40.8%) consecutive aspirates from tuberculous nodes. Acid-fast bacilli and/or microscopic caseation were seen in 116 out of 155 (74.8%) aspirates from tuberculous nodes for which smears stained both by Ziehl-Nielsen and haematoxylin & eosin were available.

CONCLUSIONS

It is recommended that all patients with suspected tuberculous lymphadenitis in Africa, undergo wide-needle aspiration before surgical biopsy or empirical treatment.