Initial work-up for cervical lymphadenopathy: back to basics

Diagnosing Kikuchi's disease on fine needle aspiration biopsy

OBJECTIVE

To investigate the diagnostic utility of fine needle aspiration (FNA) smear, cell block (CB), flow cytometry (FC) and tuberculosis polymerase chain reaction (Tb-PCR) analysis for Kikuchi's disease (KD).

METHODS

A total of 173 FNA biopsy samples were collected using a Youyi aspirator. KD was diagnosed by FNA smear, with or without, CB, FC and Tb-PCR.

RESULTS

Out of 173 patients, 131 (75.7%) were female and 126 (72.8%) aged 21-40 years. Of these, 171 patients (98.8%) presented with painful enlarged cervical lymph nodes. All cytological samples identified intracellular apoptotic debris embedded in the cytoplasm of crescentic and phagocytic macrophages. In 24 cell-blocks (CBs), clusters of CD123 positive plasmacytoid monocytes were observed in KD. FC and CBs showed non-specific lymphoid hyperplasia in nine cases with suspicious lymphoma. Tb-PCR was negative in five cases with suspicion of tuberculosis.

CONCLUSIONS

In summary, FNA biopsy is a fast, reliable, and relatively inexpensive diagnosis tool for KD. CB preparation is an important adjunct method for the diagnosis of KD.

The efficacy of the interferon-γ release assay for diagnosing cervical tuberculous lymphadenitis: A prospective controlled study

OBJECTIVES/HYPOTHESIS

The whole-blood interferon (IFN)-γ release assay (IGRA) has been studied mainly for diagnosing latent tuberculosis (TB). We prospectively evaluated its diagnostic usefulness in patients with suspected cervical TB lymphadenitis.

STUDY DESIGN

Prospective cohort study.

METHODS

An IGRA was performed in subjects with suspected TB lymphadenitis. To evaluate the diagnostic performance of the IGRA, we calculated the sensitivity and specificity of culture, radiologic imaging, polymerase chain reaction testing, fine needle aspiration, and excisional biopsy.

RESULT

Of the 271 adult patients with suspected TB lymphadenitis, 42 were diagnosed with the disease. The overall sensitivity and specificity of the IGRA were 78.8% and 95.5%, respectively. When the cutoff value of IFN-γ was set to 0.26 IU/mL, it met the inclusion criteria for suspicious TB lymphadenitis, with sensitivity and specificity of 83.3% and 95.1%, respectively.

CONCLUSIONS

The IGRA is useful in diagnosing TB lymphadenitis, with high sensitivity and specificity.

LEVEL OF EVIDENCE

4.

Diagnostic role of core needle biopsy in cervical lymphadenopathy

BACKGROUND

The purpose of this study was to evaluate the value of core needle biopsy (CNB) compared to fine-needle aspiration cytology (FNAC) in cervical lymphadenopathy.

METHODS

This consecutive case series enrolled 208 patients with cervical lymphadenopathy. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were evaluated and the necessity of an additional open biopsy was compared.

RESULTS

The sensitivity and NPV for critical disease (lymphoma, carcinoma, and tuberculosis) were significantly higher with CNB (p = .006, p = .001, respectively) than with FNAC. In the analysis based on specific disease, the sensitivity of CNB was statistically significantly higher (p = .009) for the diagnosis of lymphoma. The rate of open biopsy for confirmative diagnosis was significantly lower with CNB (p = .014).

CONCLUSION

CNB is beneficial for initial examination in cervical lymphadenopathy and showed higher sensitivity and NPV than FNAC. It is especially useful for screening for lymphoma.