Letter to the Editor
Diagnostic approaches in tuberculous lymphadenitis
Abordagem diagnóstica na tuberculose ganglionar
F. Soares Piresa,
, M. van Zellera, R. Reisb,c, A. Carvalhoc,d, R. Duartec,d,e,f
Corresponding author
a Serviço de Pneumologia, Centro Hospitalar de São João, Porto, Portugal
b Serviço de Pneumologia, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
c Centro de Diagnóstico Pneumológico, Vila Nova de Gaia, Portugal
d Serviço de Pneumologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
e Centro de Referência Regional para a Tuberculose Multirresistente, Região Norte, Vila Nova de Gaia, Portugal
f Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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Patients were referred after diagnosis, either to start or continue treatment. They all had a positive response to anti-bacillary treatment.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Positive cyto/histological results were defined as findings of histological features compatible with TB<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> (granulomatous inflammation and epithelioid cells with/without Langhans cells, caseous necrosis or positive Ziehl–Nielsen stain in lymph node (LN) samples). Positive microbiological results were defined as positive results on smear, culture or nucleic acid amplification test (NAAT).</p><p id="par0030" class="elsevierStylePara elsevierViewall">We received 60 patients with TB lymphadenitis, 26 male and 34 female, with a mean age of 52.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>20.8 years. They were all tested for human immunodeficiency virus (HIV) and 8 tested positive. Collection of LN tissue was performed through fine-needle-aspiration cytology (FNAC) in 34 (56.7%) and through excision in 24 (40%). For 2 patients there was no information.</p><p id="par0035" class="elsevierStylePara elsevierViewall">A cyto/histological analysis was performed on 51/53 patients (there was no information on 7), which was positive for 50/51 (98%) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). A microbiological analysis was performed on 29/59 (no information on 1 patient), which was positive in 24 (82.8%). A positive smear was found in 14/29 (48.3%), positive culture in 19/28 (67.9%) and positive NAAT in 14/16 (87.5%) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). No differences were found between the microbiologically tested group and other patients, in terms of sex, age, HIV-infection, previous TB and recent TB contact. No differences in diagnostic yield were found between FNAC and excision.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">It becomes clear that in the approach to lymphadenitis it is still not routine to send LN samples for both cyto/histological and microbiological analyses. Since the diagnostic process was not conducted in our center, it is not possible to exclude the presence of bias on the cohort that was microbiologically assessed, whether these patients had a higher suspicion for TB or not.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Culture for <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> is the primary diagnostic standard,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> not only for diagnosis, but also to provide information about drug susceptibility. However, it is time-consuming and sensitivity is not very high (43–88%).<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> When cyto/histological analysis is combined with smear and culture results the diagnostic efficacy of NAAT did not improve. However, there are some important advantages of NAAT, such as immediate response, high specificity<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> and the possibility of molecular resistance tests, when drug resistance is suspected.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">These results strengthen the case for increased suspicion of TB lymphadenitis and for utilization of a combination of cytology/histology and microbiology in diagnostic approaches to lymphadenitis.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data and that all the patients included in the study received sufficient information and gave their written informed consent to participate in the study.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Soares Pires F, van Zeller M, Reis R, Carvalho A, Duarte R. Abordagem diagnóstica na tuberculose ganglionar. Rev Port Pneumol. 2013;19:237–238.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 798 "Ancho" => 3007 "Tamanyo" => 177835 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Diagnostic approaches and results in all included TB lymphadenitis patients (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>60) (left) and a venn-type diagram including only patients who performed all analyses (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>13) (right).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nodal tuberculosis revisited: a review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "U. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 12 | 8 | 20 |
| 2024 October | 73 | 40 | 113 |
| 2024 September | 58 | 32 | 90 |
| 2024 August | 66 | 36 | 102 |
| 2024 July | 67 | 31 | 98 |
| 2024 June | 61 | 33 | 94 |
| 2024 May | 54 | 44 | 98 |
| 2024 April | 57 | 29 | 86 |
| 2024 March | 42 | 29 | 71 |
| 2024 February | 37 | 29 | 66 |
| 2024 January | 41 | 30 | 71 |
| 2023 December | 41 | 25 | 66 |
| 2023 November | 49 | 43 | 92 |
| 2023 October | 34 | 32 | 66 |
| 2023 September | 34 | 31 | 65 |
| 2023 August | 31 | 17 | 48 |
| 2023 July | 38 | 39 | 77 |
| 2023 June | 30 | 11 | 41 |
| 2023 May | 46 | 28 | 74 |
| 2023 April | 24 | 8 | 32 |
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