Sunil Baburao Jadhav1, Raghavendra Pedditi Reddy2, Ashish Shankarrao Deshmukh3, Shivprasad Pandurang Kasat4, Hafiz Rajmohammad Deshmukh5
There are nearly 9 million new cases and 2 million deaths from tuberculosis worldwide every year.1 The incidence of mycobacterial lymphadenitis has increased in parallel with the increase in the incidence of mycobacterial infection worldwide. Tubercular lymphadenitis is seen in nearly 35 percent of extrapulmonary tuberculosis. Cervical lymph nodes is the most common site of involvement.
MATERIALS AND METHODS
Every patient out of 116 patients with TB cervical lymphadenitis was investigated with chest x-ray, sputum for AFB, Mantoux test, USG neck, FNAC, FNAC culture on LJ media and excision biopsy.
Biopsy of cervical lymph node is the best investigation for diagnosis of tubercular lymphadenitis and hence considered as a gold standard. The sensitivity of Mantoux test was 82.4% and specificity was 68.6%. Sensitivity of FNA culture on LJ media was 84.6% and specificity was 72.3%. Sensitivity of FNAC was 84.1% and specificity was 65.5%. Sensitivity of ultrasonography was 92.4%, whereas specificity was 64.2% and sensitivity of excision biopsy was 96.4% and specificity was 88.4%.
On comparison with lymph node biopsy, ultrasonography of neck showed high sensitivity followed by FNA culture on LJ medium, FNAC and Mantoux test, whereas on comparing specificity, FNA culture on LJ medium had a high specificity followed Mantoux test, FNAC and ultrasonography. To achieve a high specificity and sensitivity for diagnosis of tubercular lymphadenitis, a combination of two or more investigations can be used, but more studies are required to evaluate the optimal combination of these investigations for accurate and cost-effective analysis.