Clinical Aspect and Management Strategy of Tuberculous Cervical Lymphadenopathy

Jeong, Han Sin; Kang, Je Hyung; Kim, Sang Woo; Song, Jae Hoon; Baek, Chung Hwan; Son, Young Ik

Abstract

BACKGROUND AND OBJECTIVES
Tuberculous cervical lymphadenopathy (TCL) is not an uncommon inflammatory disorder. Yet, the management strategy of TCL is controversial and there are no clear answers for when, how and to whom surgical intervention should be applied. This study aimed to analyze the efficacy of antituberculous chemotherapy (AC) and surgical treatment to provide the guidelines of surgical intervention. MATERIALS AND METHODS: A retrospective chart review was carried out for 153 patients with TCL who were treated between Jan. 1998 and Jun. 2001 at Samsung Medical Center, Seoul, Korea. AC was provided for all the patients as an initial treatment. Surgical intervention was combined for the patients who were refractory to the medical management. Treatment results of AC and indications of the surgical intervention were analyzed. RESULTS: AC, as a sole treatment modality, was successful in most (83.7%) of the patients while combined surgical intervention was needed for 16.3%. Overall cure rate (remnant mass size < or =5 mm) was 96.3%. Surgery was provided for the TCL showing progression even after the initiation of AC or not responding to AC within 3 months. The necrotic lymph node less than 4 cm in its size did not need surgical intervention when there was a rapid decrease of size within 2 weeks of AC. For the skin lesions of impending rupture or overt draining sinus, surgical intervention shortened the duration of treatment required for the wound healing. CONCLUSION: Most of TCL can be effectively controlled with AC alone. It would be reasonable to reserve surgical interventions for the TCL with 1) abscess greater than 4 cm in its size, 2) abscess not rapidly responding to AC regardless of its size, 3) draining skin wound, and 4) non-necrotic nodes with poor response to AC over 3 months. Gross total removal of TCL would be preferred for shortening the duration of wound care to drainage procedures including curettage, incision and drainage or simple dressing.