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Bacteriological methods as add on tests to fine-needle aspiration cytology in diagnosis of tuberculous lymphadenitis: can they reduce the diagnostic dilemma?

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dc.contributor.author Abdissa, K.
dc.contributor.author Tadesse, M.
dc.contributor.author Bezabih, M.
dc.contributor.author Bekele, A.
dc.contributor.author Apers, L.
dc.contributor.author Rigouts, L.
dc.contributor.author Abebe, G.
dc.date.accessioned 2015-03-18T09:25:57Z
dc.date.available 2015-03-18T09:25:57Z
dc.date.issued 2014
dc.identifier.issn 1471-2334
dc.identifier.doi http://dx.doi.org/10.1186/s12879-014-0720-z
dc.identifier.other ITG-C5A
dc.identifier.other ITG-B6A
dc.identifier.other MULTI
dc.identifier.other DCS
dc.identifier.other U-STDCLI
dc.identifier.other DBM
dc.identifier.other U-MYCOB
dc.identifier.other JIF
dc.identifier.other DOI
dc.identifier.other URL
dc.identifier.other FTA
dc.identifier.other OAJ
dc.identifier.other E-only
dc.identifier.other Abstract
dc.identifier.other UPD58
dc.identifier.uri http://hdl.handle.net/10390/8314
dc.description.abstract Background: The diagnostic accuracy of fine-needle aspiration (FNA) cytology for the diagnosis of tuberculous lymphadenitis (TBLN) is confounded by mimicking cytomorphologic disorders. The objective of this study was to determine whether supplementing FNA cytology with bacteriological methods improves the overall accuracy of TBLN diagnosis. Methods: Two hundred presumptive TBLN cases were included in the study. FNA specimens were collected and examined for cytomorphologic changes, for acid-fast bacilli (AFB) by microscopy and for mycobacterial growth on culture. Culture was done using Lowenstein-Jensen (LJ) medium and mycobacteria growth indicator tube (BACTEC MGIT 960 TB detection system). Differentiation between M. tuberculosis complex (MTBc) and non-tuberculous mycobacteria (NTM) was done by using 500 inverted question markg/ml para-nitrobenzoic acid (PNB) susceptibility testing. Results: Cytomorphology detected TBLN among 80% (160/200) of the presumptive cases. Culture results were available for 188 cases. Twelve samples were excluded due to contamination on both culture methods. Culture confirmed cases accounted for 78% (147/188) of which MTBc constituted 97.3% (143/147). Among presumptive cases, classified by FNA cytology as `abscess inverted question mark, 11 were culture positive. Microscopy detected 31.3% (46/147) of culture confirmed mycobacterial lymphadenitis of which 11% (4/37) were diagnosed non-suggestive for tuberculosis (TB) by FNA cytology. Compared to culture (LJ & BACTEC MGIT 960) and AFB microscopy as composite gold standard, FNA cytology had a sensitivity of 88.4% and a specificity of 48.8%. The positive predictive value was 86.1% while the negative predictive value was 54.1%. The confirming power and the ROC curve area was 1.73 and 0.69, respectively. Conclusion: FNA cytology showed a relatively high sensitivity but a low specificity. Combining bacteriological methods with FNA cytology in an endemic region like Ethiopia improves the overall accuracy of the diagnosis of mycobacterial lymphadenitis, which in turn may lead to better patient management. en_US
dc.language English en_US
dc.subject Bacterial diseases en_US
dc.subject Tuberculosis en_US
dc.subject Mycobacterium tuberculosis complex en_US
dc.subject Nontuberculous en_US
dc.subject Lymphadenitis en_US
dc.subject Diagnosis en_US
dc.subject Cytology en_US
dc.subject Fine-needle aspiration en_US
dc.subject Accuracy en_US
dc.subject Acid-fast bacilli en_US
dc.subject Microscopy en_US
dc.subject Drug susceptibility en_US
dc.subject Specificity en_US
dc.subject Sensitivity en_US
dc.subject Predictive value en_US
dc.subject Laboratory techniques and procedures en_US
dc.title Bacteriological methods as add on tests to fine-needle aspiration cytology in diagnosis of tuberculous lymphadenitis: can they reduce the diagnostic dilemma? en_US
dc.type Article-E en_US
dc.citation.issue 720 en_US
dc.citation.jtitle BMC Infectious Diseases en_US
dc.citation.volume 14 en_US
dc.citation.pages 1-6 en_US
dc.identifier.pmid http://www.ncbi.nlm.nih.gov/pubmed/25551280
dc.identifier.url http://www.biomedcentral.com/1471-2334/14/720
dc.citation.jabbreviation BMC Infect Dis en_US


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