Ultrasound-Guided Needle Aspiration Biopsy for Superficial Cervical Lymphadenopathy: Diagnostic Yield Beyond Tuberculosis

Background: Superficial cervical lymphadenopathy frequently requires tissue sampling because infectious, inflammatory, and malignant diseases often share overlapping clinical and radiological features. Although ultrasound-guided sampling of superficial cervical lymph nodes is well established, the available literature predominantly focuses on fine-needle aspiration cytology (FNAC) or core needle biopsy (CNB). Comparatively less data specifically describe aspiration-based tissue acquisition providing material for combined histopathological, microbiological, and molecular analyses, particularly in very small cervical lymph nodes. We describe our single-center experience with ultrasound needle aspiration biopsy (US-NAB), focusing on technical feasibility, sample adequacy, diagnostic contribution, and procedural safety. Methods: We retrospectively analyzed 20 consecutive patients referred to a tertiary respiratory infectious diseases center between April 2023 and June 2024 for suspected cervical tuberculous lymphadenopathy. All patients underwent real-time US-NAB using an 18-gauge modified Menghini aspiration needle. Biopsy specimens were processed, as applicable, for histopathology, acid-fast bacilli smear microscopy, molecular testing (real-time PCR), and mycobacterial culture. Diagnostic yield, final diagnoses, lymph node size, and procedural safety were evaluated. Results: A final diagnosis of tuberculosis was established in 13 patients (65%), while seven patients (35%) received alternative diagnoses, including metastatic malignancies (20%), sarcoidosis (10%), and bacterial lymphadenitis (5%). Adequate material contributing to a definitive diagnosis was obtained in all 20 procedures (20/20). Notably, 60% of sampled lymph nodes measured <15 mm in short-axis diameter, including two nodes measuring only 5–6 mm. Histopathology was diagnostic of tuberculosis in eight patients, whereas five additional cases with nonspecific necrosis were confirmed by positive TB-PCR. No major procedure-related complications, including bleeding, pneumothorax, or pneumomediastinum, were observed. Conclusions: In this small single-center cohort, US-NAB was feasible and safe and provided adequate material for histopathological, microbiological, and molecular analyses, including when very small superficial lymph nodes were sampled. Beyond confirming tuberculosis, the procedure contributed to the identification of alternative benign and malignant diagnoses. These findings support further evaluation of US-NAB as a complementary sampling option in the diagnostic work-up of superficial cervical lymphadenopathy.