Clinical characteristics and immunodiagnostic efficacy validation of cervical lymph node tuberculosis: a retrospective study based on clinically confirmed cases

This study aimed to investigate the clinical characteristics and diagnostic performance of immunological tests in cervical tuberculous lymphadenitis (CTBL) across different age cohorts, providing reference for early clinical identification and diagnosis. A retrospective cohort study was conducted, enrolling patients with pathologically confirmed CTBL who completed the WHO-recommended anti-tuberculosis treatment regimen at the Department of Oral and Maxillofacial Surgery of the Kashi Prefecture Second People’s Hospital, Xinjiang between January 2018 and January 2025. Participants were stratified into pediatric (< 18 years), adult (18–60 years), and geriatric (> 60 years) cohorts. Comparative analyses were performed regarding: (1) history of tuberculosis (TB) or exposure; (2) clinical symptoms (e.g., cutaneous ulceration, weight loss, afternoon low-grade fever, persistent fatigue); and (3) positivity rates of immunological tests, including tuberculin skin test (TST), interferon-γ release assays (IGRA), and TB antibody assays. Categorical variables were analyzed using Pearson’s χ 2 test, with P < 0.05 considered statistically significant. A total of 111 patients were included (female: 60.4%, male: 39.6%), distributed as: pediatric ( n = 26, 23.4%), adult ( n = 73, 65.7%), and geriatric ( n = 12, 10.8%). Most patients had no definitive TB history or exposure, with no significant intergroup differences ( P > 0.05). Approximately half exhibited one or more systemic symptoms, but few presented with the full classic symptom spectrum, and no significant intergroup variations were observed ( P > 0.05). Immunological testing revealed TST positivity rates of 65.4, 76.7, and 66.7%, and IGRA positivity rates of 65.4, 78.1, and 66.7% in pediatric, adult, and geriatric cohorts, respectively, whereas TB antibody positivity was notably lower (23.1, 27.4, 25.0%), with no significant intergroup differences ( P > 0.05). The proportion of patients with all-negative results was low, with most showing at least one positive result (77.0, 80.3, 75.0%, respectively). Rates of all-positive results were also low, again without significant intergroup differences ( P > 0.05). Combined testing demonstrated dual positivity (TST+IGRA) rates of 53.8, 71.2, and 58.3% across cohorts, with no significant differences ( P > 0.05). Systemic symptoms and immunological tests can serve as useful adjuncts for screening cervical tuberculous lymphadenitis in pediatric, adult, and geriatric patients. Nevertheless, histopathological examination remains the diagnostic cornerstone and should be combined with microbiological testing within a comprehensive diagnostic strategy. For cases with negative immunological tests but high clinical suspicion for the disease, a biopsy should be performed following risk assessment, concomitant with nucleic acid amplification testing, to prevent misdiagnosis and treatment delays.