A clinical review of 38 cases of cervical tuberculous lymphadenitis in Japan - The role of neck dissection

Value of Contrast-Enhanced Ultrasound in the Ultrasound Classification of Cervical Tuberculous Lymphadenitis

Purpose

The purpose of this study was to investigate the clinical value of contrast-enhanced ultrasound (CEUS) in the ultrasound (US) classification of cervical tuberculous lymphadenitis (CTL).

Materials and Methods

This retrospective study included 70 patients diagnosed with CTL. All patients underwent both conventional US and CEUS. Both methods were compared to determine their agreement with pathological CTL results.

Results

The results of conventional US classification were as follows: 18 patients (25.7%) were type I, 25 patients (35.7%) type II, 21 patients (30.0%) type III, and 6 patients (8.6%) type IV, respectively. The results of CEUS classification were as follows: 9 patients (12.9%) were type I, 33 patients (47.1%) type II, 22 patients (31.4%) type III, and 6 patients (8.6%) type IV. Conventional US classification and pathological results showed moderate agreement in terms of US classification results for CTL (Kappa = 0.693); the accuracy of conventional US classification was 78.6% (55/70), and the accuracy of types II and III were 71.0% (22/31) and 82.6% (19/23), respectively. CEUS classification and pathological results showed strong agreement (Kappa = 0.871); the accuracy of CEUS classification was 91.4% (64/70), and the accuracy of types II and III were 93.6% (29/31) and 87.0% (20/23), respectively.

Conclusion

In combined with conventional US, CEUS could provide more information on blood flow enhancement patterns and identify the area of lymph node necrosis in CTL. This could contribute to a more accurate US classification of CTL.

The value of multimodal ultrasonography in differential diagnosis of tuberculous and non-tuberculous superficial lymphadenitis

Background

To investigate the value of multimodal ultrasonography in differentiating tuberculosis from other lymphadenopathy.

Methods

Sixty consecutive patients with superficial lymphadenopathy treated at our hospital from January 2017 to December 2018 were categorized into four types based on the color Doppler ultrasound, five types based on contrast-enhanced ultrasound, and five types based on elastography. Sensitivity and specificity were calculated of all the three imaging, including color Doppler examination, contrast-enhanced ultrasound and one individual multimodal method, for detecting lymph nodes.

Results

A total of 60 patients were included in the final analysis. Of those, Mycobacterium tuberculosis was positive in 38 patients and negative in 22 patients. Among the 38 patients who were positive for Mycobacterium tuberculosis, of which 23 had a history of pulmonary tuberculosis, accounting for 60.53% of the positive cases, and the remaining patients did not combine lesions of other organs. Among the 60 superficial lymph nodes, 63.3% presented with tuberculous lymphadenitis. The sensitivity, specificity, and accuracy of the color Doppler examination were 73.68%, 68.18%, and 71.67%, respectively. The sensitivity, specificity and accuracy of contrast-enhanced ultrasound were 89.47%, 63.64% and 80.00%, respectively. The sensitivity, specificity and accuracy of the elastography were 63.16%, 63.64% and 63.33%, respectively. The sensitivity, specificity and accuracy of one individual multimodal method were 42.11%, 95.45% and 61.67%, respectively. The sensitivity, specificity and accuracy of all modes combined were 100.00%, 27.27% and 73.33%, respectively.

Conclusion

Multimodal ultrasonography has high predictive value for the differential diagnosis of superficial tuberculous lymphadenitis.

The rare multidrug cervical tubercular lymphadenitis in an infant from Iran: A case report and literature review

Cervical-TB lymphadenitis is the most frequent extrapulmonary manifestation of tuberculosis infection. There are limited documents (only five documents) on multidrug-resistant cervical tubercular lymphadenitis, but there is no evidence for MDR-cervical tuberculosis lymphadenitis in infants, which may occur in TB endemic regions.

Treatment of cervical lymph node tuberculosis: When surgery should be performed? A retrospective cohort study

Background

lymph node tuberculosis is the most common form of extra pulmonary tuberculosis. Although diagnosis is usually difficult, therapeutic management remains a challenge and a subject of national and international debate.

Materials and methods

the medical records of patients with cervical lymph node tuberculosis who were treated at 20 August Hospital, Casablanca, Morocco, between May 2017 and November 2018 were reviewed. The results of the treatment were analyzed retrospectively.

The aim of our work was to identify all causes of medical treatment failure in cervical lymph node tuberculosis, and to propose indications for the use of surgery in cervical lymph node tuberculosis in Morocco.

Results

Out of a total of 104 patients, the mean age was 24 years, the sex ratio was 0.51 (women: 66.3%), twenty (19.2%) patients received medical treatment alone, and 84 (80.8%) patients required medical and surgical treatment. Surgery was required when the size of the lymphadenopathies was greater than or equal to 3 cm (p = 0.005), when the patient presented with an abscess and/or fistula(p = 0.005), when the patient presented with resistance to antibacillary drugs(p = 0.032), or developed a paradoxical upgrading reactions (p = 0.001), or when the patient had a recurrence of lymph node tuberculosis(p = 0.008) on multivariate analysis.

Conclusion

antibiotic therapy remains the main treatment for all patients in lymph node tuberculosis, but the results of our work show the value of surgery in some indications.

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Our goal in this study was to identify causes of the failure of medical treatment in lymph node tuberculosis, to propose indications for surgery.

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The study has compared patients who were reported to be cured under medical treatment alone after a lymph node biopsy, and patients who required surgery after failure of medical treatment in lymph node tuberculosis.

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We recommend surgery when we have: adenopathies ≥3 cm in diameter, abscesses, and fistulas, recurrence, resistance to antibacillary drugs, and paradoxical upgrading reaction.

Diagnostic value of T-Spot TB combined with INF-γ and IL-27 in tuberculous pleurisy

The purpose of the present study was to investigate the diagnostic value of T cells spot test (T-Spot TB) combined with interferon-γ (INF-γ) and interleukin-27 (IL-27) in tuberculous pleurisy. Sixty patients with tuberculous pleurisy (observation group) and 60 patients with non-tuberculous pleurisy (control group) were enrolled in this study. T-Spot TB was performed to detect the pleural effusion of two groups of patients. Levels of IFN-γ and IL-27 in serum and pleural effusion were detected by enzyme-linked immunosorbent assay (ELISA). Relative expression of IFN-γ mRNA and IL-27 mRNA in peripheral blood mononuclear cells were detected by RT-PCR. Positive rate of T-Spot TB in observation group was 96.7% (58 cases), which was significantly higher than that in control group (p<0.05). Concentration of INF-γ in pleural effusion of observation group was 468.6±24.8 ng/l, which was significantly higher than that in control group (131.3±18.7 ng/l, p<0.05). Concentration of IL-27 in pleural effusion of observation group was 423.4±37.2 ng/l, which was significantly higher than that in control group (116.2±15.5 ng/l, p<0.05). Concentrations of INF-γ and IL-27 in serum of observation group were 48.2±13.4 and 41.7±10.6 ng/l, respectively, which were significantly higher than those in control group (38.6±11.2 and 35.3±8.4 ng/l, p<0.05). Relative expression levels of INF-γ mRNA and IL-27 mRNA in observation group were significantly higher than those in control group (p<0.05). Therefore, combination of T-Spot TB with INF-γ and IL-27 has significant application value in the clinical diagnosis of tuberculous pleurisy, and should be popularized.