Tuberculosis of the Lymph Glands of the Neck: A Limited Role for Surgery

Lymph node dissection effectively shortens the course of anti-tuberculosis treatment

Objective

To evaluate the clinical efficacy of postoperative ultra-short-course chemotherapy in treating cervical lymph node tuberculosis in the Wuhan region.

Methods

Follow-up of patients in the surgery and non-surgery group after discharge, evaluating the number of cervical lymph nodes during the administration of antituberculosis drugs.

Results

The age of the patients in the surgical therapy group ranged from 6 to 83 years old with an average age of 45 and a standard deviation of 20. The number of cervical lymph nodes in the patients ranged from 1.61 to 8.15. The average antituberculosis treatment duration before surgery for patients in the surgical group was 98.02 days, while for patients in the non-surgical group it was 96.13 days. The average length of hospital stay for patients receiving surgical treatment was 12.76 days, while for patients receiving non-surgical treatment it was 8.74 days. The average antituberculosis treatment duration after discharge for patients in the surgical group was 205 days, with a standard deviation of 42.39, while for patients in the non-surgical group it was 372 days, with a standard deviation of 71.54. The T-test results for antituberculosis treatment during hospitalization and after discharge were 98.3x10-10 and 5.02x10-67, respectively.

Conclusion

After surgical treatment of cervical lymph node tuberculosis, the effectiveness of a 4-6 month short-course chemotherapy in Wuhan region is not weaker than the effectiveness of a conventional 6-9 month drug treatment.

Diagnosis and Management of Occult Cervical Tuberculous Lymphadenopathy

Objective: Some cervical tuberculous lymphadenopathy (CTL) presents no evidence of tuberculosis (TB), even after thorough examination of a fine-needle aspiration (FNA) specimen. After the examination of excisional specimens, when the polymerase chain reaction (PCR) analysis identifies the nucleic acid of Mycobacterium tuberculosis (Mtb) or the culture results are positive, then the diagnosis of CTL is established. We refer to this condition as occult CTL (OCTL). Patient and Methods: The present work is a retrospective review of a consecutive series of OCTL cases that were treated at the Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, between June 2015 and September 2020. When the diagnosis of OCTL was established, the patients received the standard anti-TB chemotherapy. Results: Fourteen cases of OCTL, including 9 female and 5 male patients, aged 24 to 71 years (median age 42 years), were included in the present study. The most commonly observed levels of lymph node involvement were level V and level II. Each level of the involved lymph nodes was removed entirely through en bloc surgical resection. An evaluation of the excisional specimens led to positive PCR results in all 14 cases, with 2 cases presenting positive culture and 3 cases exhibiting positive acid-fast bacilli (AFB) staining. Recovery was uneventful, and the anti-TB chemotherapy was completed in all cases. The median duration of follow-up was 29 months, during which no case of TB relapse was observed. Conclusions: Wide surgical excision is crucial for the diagnosis and management of OCTL, and when used in combination with anti-TB chemotherapy, it results in satisfactory patient outcomes.