Diagnosis of Cervical Tuberculous Lymphadenitis

Sim, Kyu Hwa; Lee, Dong Wook; Choo, Moo Jin; Shin, See Ok; Choi, Young Seok; Shin, Jeong Woo; Jeon, Cheong Woo; Lee, Chang Su

Abstract

BACKGROUND AND OBJECTIVES: Although the incidence of tuberculosis has decreased recently, cervical tuberculous lymphadenitis is one of the most common causes of neck mass in Korea. Its confirmative diagnosis is not common, especially when the presence of acid-bacilli is not proven. So, the treatment of cervical tuberculous lymphadenitis is generally carried out by clinical diagnosis, not by confirmative diagnosis. In this study, we designed to verify theusefulness of fine needle aspiration cytology (FNAC), AFB stain, Mycobacterium tuberculosis polymerase chain reaction (PCR) and excisional biopsy prospectively.
MATERIALS AND METHODS
We underwent FNAC, AFB stain and PCR as a first stage work-up through fine needle aspiration in forty-eight patients who were suspected of cervical tuberculous lymphadenits. In patients with positive results on the first stage work-up, we treated the patients with antituberculosis chemotherapy under clinical diagnosis of tuberculosis. In patients with negative test results, we performed excisional biopsy. Also in patients who revealed positive results with no response to the antituberculosis chemotherapy, we performed an excisional biopsy too.
RESULTS
The sensitivity and specificity of first stage work-up were 64.9% and 81.8%, respectively. The sensitivity of FNAC, AFB stain and PCR were 8.1%, 13.5% and 56.8 %, respectively. The specificity of PCR was 81.8%. Thirteen (59.1%) of 22 patients who revealed negative results in their first stage work-up were proven to have cervical tuberculous lymphadentis through excisional biopsy, and two of the positive results in PCR were false positive.
CONCLUSION
In clinical diagnosis of cervical tuberculous lymphadentis, the first stage work-up used in this study is found to be useful methods which resulted 64.9% sensitivity and 81.8% specificity. Especially, PCR is the most useful tool among them and suggest that, if its result is negative, excisional biopsy should be considered positively.