Minimally Invasive Diagnosis of Tubercular Lymphadenitis – The Role of Fine Needle Aspiration Cytology

Abstract Background: Tuberculosis is a leading cause of enlarged lymph nodes in developing countries. Fine needle aspiration cytology (FNAC) is an easy to perform, rapid, affordable and effective outpatient diagnostic procedure for evaluating lymphadenopathies. Aim: Study various cytomorphological patterns in tubercular lymphadenitis and correlate with the AFB positivity. Material and Methods: FNAC smears of 820 cases diagnosed as tuberculous lymphadenitis in the Department of Pathology, RBIPMT, Delhi over a period of 1 year was reviewed. All the smears stained by May Grunwald Giemsa and Ziehl-Neelsen stain for acid fast bacilli were evaluated. Results: The disease was most frequently observed in third decade with female preponderance. Cervical lymph nodes were the most common nodes to be involved. Among the four cytomorphological patterns on FNAC, maximum cases demonstrated caseous necrotic material with degenerated inflammatory cells. Ziehl-Neelsen staining showed overall AFB positivity of 59.6%. Maximum AFB positivity was noted in cases having caseous necrotic material and degenerated inflammatory cells. Conclusion: FNAC enables early detection of extrapulmonary tuberculosis based on cytomorphological evaluation and ZN stain for AFB, facilitating timely treatment and ultimately decreasing the morbidity and mortality.