Comparison of routine cytology findings with conventional ziehl-neelsen method and fluorescent method for detection of acid fast bacilli in fine needle aspirates from suspected cases of tuberculous lymphadenitis
Abstract
Objective: This study aimed to correlate the modified fluorescence stain method and conventional ZN method with routine cytology findings on lymph node aspirates for the detection of AFB in suspected cases of tuberculous lymphadenitis.
Material and Methods: After adequate fine needle aspiration, aspirates were examined for cytology diagnosis, studied with Ziehl-Neelsen and Auramine-rhodamine Fluorescent stain. Cytological findings, ZN stain observations and grading were compared with fluorescent stain grading.
Result: In our study, 36 cases were reported positive by fluorescent staining method for M. tuberculosis. Out of 43 granulomatous lymphadenitis cases diagnosed by FNAC, 29 cases were reported positive for acid fast bacilli by Z-N staining. 11 cases were found as false negative (22%). Sensitivity and specificity of Z-N method was found to be 70.27% and 76.92% respectively. And for cytological method it was 96.77% and 31.57% respectively.
Conclusion: There are problems in arriving at an absolute diagnosis in certain cases of tuberculous lymphadenitis when the aspirate shows polymorphous picture with occasional epithelioid cells and absence of typical Langhans giant cell or caseous necrosis. Microscopy has many advantages when it comes to speed & feasibility, its sensitivity could be improved by adjuvant methods.
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References
Raviglione MC, O’Brien RJ. Mycobacterial diseases: Tuberculosis. Harrison’s Principles of Internal Medicine 19th Edition. New York: McGraw Hill Education. 2015:1102-1122.
TB India 2019 revised National TB control programme annual report 2019.
Daniel TM. Rapid diagnosis of tuberculosis: laboratory techniques applicable in developing countries. Rev Infect Dis. 1989;11(2):S471-S478.
Annam V, Kulkarni MH, Puranik RB. Comparison of the modified fluorescent method and conventional Ziehl–Neelsen method in the detection of acidfast bacilli in lymphnode aspirates. Cyto J. 2009;6:13. doi: 10.4103/1742-6413.53887.
Reza LW, Satyanarayna S, Enarson DA, Kumar AM, Sagili K, Kumar S, et al. LED-fluorescence microscopy for diagnosis of pulmonary tuberculosis under programmatic conditions in India. PLoS One. 2013; 8(10):e75566. doi: https://doi.org/10.1371/journal.pone.0075566.
Wright CA, Hesseling AC, Bamford C, Burgess SM, Warren R, Marais BJ. Fine-needle aspiration biopsy: a first-line diagnostic procedure in paediatric tuberculosis suspects with peripheral lymphadenopathy? Int J Tubercul Lung Dis. 2009;13(11):1373-1379.
A. Jain, A. Bhargava, and S. K. Agarwal, A comparative study of two commonly used staining techniques for acid fast bacilli in clinical specimens. Ind J Tuber. 2002;49:161-162.
Brijesh Thakur, Ravi Mehrotra, Jitendra Singh Nigam Correlation of Various Techniques in Diagnosis of Tuberculous Lymphadenitis on Fine Needle Aspiration Cytology. Pathol Res Int.
;824620. doi: http://dx.doi.org/10.1155/2013/824620.
Krishna M, Kumar A, Tuberculous mycobacteria bacilli fluorescence and compare with Ziehl- Neelsen stain in fine-needle aspiration cytology of tubercular lymphnode. Int J Otorhinolaryngol Head Neck Surg. 2016;2(2):66-69. doi: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20160956.
Vamseedhar A, Kulkarni MH, Puranik BR. Comparison of the modified fluorescent method and conventional Ziehl–Neelsen method in the detection of acidfast bacilli in lymphnode aspirates Cyto J. 2009;6(1):13. doi: 10.4103/1742-6413.53887.
Ben-Selma W, Ben-Kahla I, Marzouk M, Ferjeni A, Ghezal S, Ben-Said M, et al. Rapid detection of Mycobacterium tuberculosis in sputum by Patho-TB kit in comparison with direct microscopy and culture. Diagn Microbiol Infect Dis. 2009;65(3):232-235. doi: 10.1016/j.diagmicrobio.2009.07.021. Epub 2009 Sep 2.
Laifangbam S, Singh HL, Singh NB, Devi KM, Singh NT.. A comparative study of fluorescent microscopy with Ziehl-Neelsen staining and culture for the diagnosis of pulmonary tuberculosis. Kathmandu Univ Med J (KUMJ). 2009;7(27):226-230.
Sahani V, Karnal A, Arora S. A comparative study of ziehl-nelson staining and auramine staining in sputum sample for the diagnosis of pulmonary tuberculosis.2017;6(6).
Lokeshwaran, R.S., Lavanya, K.B., Dhanalakshmi, A., Keerthivasan, S. and Yogalakshmi, S., 2018. Comparison of auramine-o stain and ziehl-neelsen stain in the detection of tuberculous bacilli in fine needle aspiration of lymph nodes. J Evol Med Dent Sci-JEMDS. 2018;7(49):5268-5272.
Maru AM, Kapadiya DN, makavana H, Lakum NR. Comparison of Z. N. staining & fluorescent microscopy in detection of M. tuberculosis bacilli in Fine needle aspiration smears. Trop J Path Micro 2018; 4(3): 242-247.doi:10. 17511/jopm. 2018. I3.02.
Daniel TM. Rapid diagnosis of tuberculosis: Laboratory techniques applicable in developing countries. Rev Infect Dis. 1989;11(2): S471-S478.
Balows A, Hausler WJ, Hermann KL, Shadomy HJ. Manual of clinical Microbiology. 5th ed. Washington: D.C: American society for Microbiology; 1991. pp. 308-311. doi: http://dx.doi.org/10.1590/S0036-46651991000600014.
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