Diagnostic accuracy of fine needle aspiration cytology in providing a diagnosis of cervical lymphadenopathy among HIV-infected patients

The Role of Surgery in the Treatment of Cervical Lymph Node Tuberculosis

Cervical lymph node tuberculosis is a public health problem in Morocco and the rest of the world. Its paucibacillary nature makes diagnosis and treatment difficult. This is a descriptive-analytical retrospective study presenting 104 cases of patients with manifestations of cervical lymph node tuberculosis confirmed by pathological examination (100%), associated in some cases with positive bacteriology (40.6%), treated and followed up in the otolaryngology (ENT) department of the Cheikh Khalifa International University Hospital (HUICK) over a period of 5 years and 9 months (from January 01, 2017, to September 30, 2022). In our study, 14 patients (i.e., 13.5%) had a history of tuberculosis (all locations); only four (i.e., 3.8%) of them had confirmed cervical lymph node tuberculosis, of which three were still under treatment: two of them presented for treatment failure (i.e., 1.9%) and one patient for a paradoxical reaction (i.e., 1%). Three pulmonary locations (i.e., 2.9%) and one mediastinal location (i.e., 1%) were found. Surgery associated with histological study was the key to the diagnosis of tuberculosis in our study. Its procedures were: excisional biopsy for 26 patients (i.e., 25%), adenectomy for 54 patients (i.e., 51.9%), lymph node dissection for 15 patients (i.e., 14.4%), and lymphadenectomy for nine patients (i.e., 8.7%). In some cases, drainage (+/- curettage) was recommended in addition to the surgical procedure in 14 patients (i.e., 13.5%). All our patients benefited from post-surgical anti-bacillary treatment. Lymphorrhea was the only operative complication and it affected two patients (i.e., 1.9%). Meanwhile, the relapse rate was 10.6% (i.e., 11 patients), the treatment failure rate was 3.8% (i.e., four patients), and the paradoxical reaction affected 2.9% (i.e., three patients). The latter had all benefited from a simple biopsy. This indicates that a more extensive surgical procedure gives better results with a better healing rate. In conclusion, anti-bacillary treatment remains the reference treatment for lymph node tuberculosis. However, surgery holds great promise as the first-line treatment in case of fistula or abscess or in the event of failure or if complications occur.

Significance of lymph node fine needle aspiration for the diagnosis of HIV-associated lymphoma in a low-resource setting

OBJECTIVE

Fine needle aspiration (FNA) is an early step in the work-up of lymphadenopathy in people with HIV (PWH). We set out to characterize the FNA cytology in PWH and report on the time to lymphoma diagnosis through the FNA clinics in the public healthcare system in Johannesburg, South Africa.

DESIGN

Retrospective review of laboratory database.

METHODS

A retrospective chart review of patients undergoing FNA through the department of cytopathology at the National Health Laboratory Service (NHLS) was undertaken. Results of FNAs performed between March and May 2018 were reviewed. Medical record chart abstraction included general demographics, HIV status, site and results of FNA, prior history of malignancy and other laboratory data.

RESULTS

Five hundred and thirty-nine lymph node FNAs were performed on PWH. Pathological findings included tuberculosis 47% (252), inadequate sampling 14% (75), reactive adenopathy 13% (71), benign disease 12% (63), suspicious for lymphoproliferative neoplasm 8% (45), other malignancy 4% (21) and inflammation 2% ( n  = 12). Only 53% (24) of lymphomas were confirmed by biopsy. Those not confirmed had a high mortality (57%) and loss to follow-up rate (29%) over the following year. The median diagnostic interval exceeded 8 weeks from time of FNA to lymphoma diagnosis.

CONCLUSION

FNA is an important screening modality in this high HIV and tuberculosis (TB) burden region. Patients with cytology suggestive for lymphoma, but without biopsy confirmation, have a high mortality rate suggesting undiagnosed lymphoma. A better understanding of the barriers to appropriate diagnostic triage for lymphoma is needed.

HIV Lymphadenopathy: Differential Diagnosis and Important Imaging Features

OBJECTIVE. The purpose of this article is to review important imaging and clinical features to help elucidate causes of lymphadenopathy in patients with HIV infection. CONCLUSION. HIV lymphadenopathy has various causes generally categorized as inflammatory or reactive, such as immune reconstitution syndrome; infectious, such as tuberculous and nontuberculous mycobacterial infections and HIV infection itself; and neoplastic, such as lymphoma, Kaposi sarcoma, and Castleman disease. It is important to consider patients' demographic characteristics, clinical presentations, CD4 lymphocyte counts, and radiologic features to identify likely causes of lymphadenopathy.

Analysis of the causes of cervical lymphadenopathy using fine-needle aspiration cytology combining cell block in Chinese patients with and without HIV infection

Background

Cervical lymphadenopathy refers to a frequently observed clinical presentation in numerous pathological conditions. A wide spectrum of diseases can cause cervical lymphadenopathy, irrespective of the fact that the patients are infected with HIV or not. The present study focuses on validating whether the causes of cervical lymphadenopathy differ significantly in HIV and non-HIV patients by using fine-needle aspiration cytology (FNAC) combining cell block.

Methods

A total of 589 patients with cervical lymphadenopathy were recruited in the FNA clinic. The samples were obtained by an auto-vacuumed syringe that benefited the sampling more materials. The cytological smears were prepared by Hematoxylin and Eosin (HE), Periodic Acid Schiff (PAS), Gomori’s methenamine silver (GMS) and acid-fast staining. Cell blocks were made if required, and immunohistochemistry stain was performed on the cell block section.

Results

The study found 453 (76.9%) patients with HIV and 136 (23.1%) patients without HIV infection. The average age of HIV-infected patients was 34.8 ± 10.2 years, which was significantly lower than that of non-HIV-infected patients (42.9 ± 18.1 years) (p < 0.01). Of all patients infected with HIV, 390 (86.1%) were males. This proportion was significantly higher than that of non-HIV-infected patients [65/136 (47.8%)] (p < 0.01). The major causes of cervical lymphadenopathy in HIV positive patients were mycobacterial infection (38.4%), reactive hyperplasia (28.9%), non-specific inflammation (19.9%), and malignant lesions (4.2%). In contrast, the most common causes in HIV negative patients were reactive hyperplasia (37.5%), malignancy (20.6%), non-specific inflammation (19.1%) and mycobacterial infection (12.5%). Opportunistic infections such as non-tuberculous mycobacteria (4.2%), cryptococcosis (1.5%), Talaromyces marneffei (1.5%) and other fungi (0.4%) were found only in HIV-infected individuals. Non-Hodgkin’s lymphoma (2.4%) was the most common malignant lesion in patients with HIV infection, followed by Kaposi’s sarcoma (0.9%) and metastatic squamous cell carcinomas (0.7%). However, the most common malignancy in non-HIV-infected patients was metastatic carcinomas (14%) including small cell carcinomas, adenocarcinomas, squamous cell carcinomas and hepatocellular carcinoma, which were noticeably greater than the HIV patients (p < 0.01).

Conclusions

There were significantly different causes of cervical lymphadenopathy in HIV infected and non-HIV infected patients. FNAC was a useful diagnostic method for differential diagnosis of cervical lymphadenopathy.

Fine needle non-aspiration cytology for the diagnosis of cervical lymph node tuberculosis: a single center experience

Introduction

The fine-needle cytology is being used as a first line of investigation in the diagnosis of head and neck swellings, as it is simple, cost effective and less invasive as compared to biopsy.

Objective

The aims of this study were to evaluate the results of the fine-needle non-aspiration cytology of cervical lymphadenopathy and to study the factors influencing the rate of non-diagnosis results.

Methods

This retrospective study was conducted on selected patients with cervical lymphadenopathy that had undergone a fine-needle non-aspiration cytology followed by a histological biopsy. The sensitivity, specificity, positive predictive value and negative predictive value of fine-needle non-aspiration cytology for diagnosing tuberculosis were estimated. The risk factors of non-diagnosis results were evaluated.

Results

The sensitivity, specificity, positive predictive value rates of fine-needle non-aspiration cytology for tuberculosis were 83.3%, 83.3%, 78.9% and 86.9% respectively. In total, 47 out of the 131 samples (35.8%) were considered non-diagnosis. Of the non-diagnosis samples, 84.2% (38 out of 47) were benign mostly due to tuberculosis (30 cases). Among the studied factors, only tuberculosis (confirmed by histopathological examination) was significantly associated with non-diagnosis cytology (p = 0.02, Odds-Ratio = 2.35).

Conclusion

Tuberculosis is currently the commonest cause of cervical lymphadenopathy in North Africa. Fine-needle non-aspiration cytology is safe and accurate in the diagnosis of cervical tuberculous lymph node that is associated with the risk of non-diagnosis cytology.

Lymphadenopathies in human immunodeficiency virus infection

This article describes the various non-neoplastic lymphadenopathies that occur in patients infected with the human immunodeficiency virus (HIV), before or during the stage of acquired immunodeficiency syndrome (AIDS). The stages that develop during the HIV infection include: primary infection (acute infection, spread of the virus, development of host immune response, and acute retroviral syndrome), chronic infection or clinical latency, and finally, the AIDS stage. Non-neoplastic lymphadenopathies can occur at any of these phases of the infection and are due to multiple causes that can be divided into infectious causes (bacterial, fungal, parasitic, viral), and reactive causes (persistent generalized lymphadenopathy and a variety of situations that they also occur in immunocompetent people such as Castleman's disease and Kikuchi-Fujimoto's disease, among others). The general, histological and immunophenotypic characteristics of these pathologies are described.

Pretracheal tuberculous abcess mimicking a thyroid swelling-A case report

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Tuberculous cervical lymphadenitis is the most common extra pulmonary manifestation (Das et al., 2016 [1], Sharma and Mohan, 2004), posterior group of cervical nodes (Baskota et al., 2004 [2]) being the most common.

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Pre tracheal lymph node involvement in the neck is very rare.

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A high degree of suspicion for tuberculosis is needed while diagnosing a lower midline swelling in the anterior neck, especially in TB- endemic areas.

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Tuberculous abscess can be easily treated with incision and drainage along with anti tuberculous drugs, thus avoiding major surgery.

Introduction

Pretracheal tubercular abscess is a rare presentation of extra pulmonary tuberculosis even in TB- endemic areas (WHO, 2014 [3]). It usually presents in posterior triangle group of lymph nodes (Baskota et al., 2004 [2]).

Presentation of case

We report a case of a lower midline swelling in anterior part of the neck of 6 months duration, with dysphagia of 1 month duration. Radiological diagnosis was established as tuberculous abscess and was drained. Patient was started on anti tuberculous treatment.

Discussion

Swellings anatomically located in the area of anterior group of lymph nodes should be dealt with high degree of suspicion for tubercular etiology especially in TB-endemic areas (WHO, 2014 [3]). Anterior group of lymph node involvement is very rare. To differentiate, proper radiological assessment is needed to differentiate between thyroid nodule and lymph node pathology.

Conclusion

Pre operative assessment is often under estimated. Adequate evaluation will avoid major surgery for a benign pathology like tuberculosis.