Cartridge-Based Nucleic Acid Amplification Test Compared to Fine Needle Aspiration Cytology in Suspected Cases of Tubercular Lymphadenitis (the Indian Experience)

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INTRODUCTION: Diagnosis of tubercular lymphadenitis is daunting as there are varied clinical presentations and no single confirmatory gold standard test. Cartridge-based nucleic acid amplification test (CBNAAT) of the lymph node is a rapid molecular diagnostic test for simultaneously detecting tuberculosis (TB) and rifampicin resistance.

AIM: To evaluate the performance of the CBNAAT test for detecting M. tuberculosis in lymph node specimens compared to fine needle aspiration cytology (FNAC).

MATERIALS AND METHODS: The study was conducted in a rural tertiary care hospital in central India. A total of 180 patients clinically suspected of tubercular lymphadenitis were included. The male-to-female ratio was 1:1.3. The average age was 33.3 years. The age group 21–40 years had the highest number of cases. The most common complaints among the patients were fever (29.4%), followed by loss of appetite (9.5%), weight loss (9.5%), and cough (6.6%). However, most patients presented to the hospital with only lymphadenopathy (44.4%). The most common site involved was the anterior cervical lymph node (78.8%), followed by the axillary group (10.5%), submandibular (2.8%), inguinal (2.8%), supraclavicular (2.2%), submental (1.7%) and infraclavicular (1.1%) group of lymph nodes. The patients were subjected to both FNAC and CBNAAT testing. Results were reported as positive or negative for M. tuberculosis as CBNAAT gives a semiquantitative estimate of the concentration of bacilli. Rifampicin resistance results were reported as detected or not detected.

RESULTS: Cytological examination of the lymph node aspirates revealed that most were tubercular lymphadenitis cases. Cytomorphological analysis of the cases of tubercular lymphadenitis revealed Type 6 (tubercular abscess) as the predominant pattern. CBNAAT testing detected 26 cases of M. tuberculosis and three cases of rifampicin resistance. The study reported a specificity of 92.92% and low sensitivity of 26.86% of combined FNAC and CBNAAT is much higher compared to only CBNAAT.

CONCLUSION: CBNAAT, along with FNAC, is a valuable addition in first-line investigations of tubercular lymphadenitis to make a timely diagnosis.

作者简介

Sneha Oommen

Mahatma Gandhi Institute of Medical Science

Email: snehaannoommen@gmail.com
ORCID iD: 0009-0007-9472-4059
印度, Sevagram

Bharat Patil

Mahatma Gandhi Institute of Medical Science

编辑信件的主要联系方式.
Email: bharatpatil@mgims.ac.in
ORCID iD: 0000-0002-3364-4967

MD, Associate Professor

印度, Sevagram

Pravinkumar Ghongade

Mahatma Gandhi Institute of Medical Science

Email: pravinghongade@mgims.ac.in
ORCID iD: 0000-0003-2219-3256

MD, Assistant Professor

印度, Sevagram

Nitin Gangane

Jawaharlal Nehru Medical College

Email: nitingangane@gmail.com
ORCID iD: 0000-0003-0190-4215

MD, Professor

印度, Belagavi

参考

  1. Global tuberculosis report 2021. Geneva: WHO; 2021.
  2. National Strategic Plan for Tuberculosis Elimination 2017–2025. March 2017 [Internet]. Available at: https://tbfacts.org/wp-content/uploads/2018/01/NSP-Draft-2017-2025.pdf. Accessed: 2023 March 23.
  3. Takhar RP. NAAT: A New Ray of Hope in the Early Diagnosis of EPTB. Emerg Med (Los Angel). 2016;6:1000328. doi: 10.4172/2165-7548.1000328
  4. Ligthelm LJ, Nicol MP, Hoek KGP, et al. Xpert MTB/RIF for rapid diagnosis of tuberculous lymphadenitis from fine-needle-aspiration biopsy specimens. J Clin Microbiol. 2011;49(11):3967–70. doi: 10.1128/jcm.01310-11
  5. Hillemann D, Rüsch–Gerdes S, Boehme C, et al. Rapid molecular detection of extra-pulmonary tuberculosis by the automated gene Xpert MTB/RIF system. J Clin Microbiol. 2011;49(4):1202–5. doi: 10.1128/jcm.02268-10
  6. Gupta V, Bhake A. Assessment of Clinically Suspected Tubercular Lymphadenopathy by Real-Time PCR Compared to Non-Molecular Methods on Lymph Node. Acta Cytol. 2018;62(1):4–11. doi: 10.1159/000480064
  7. Goyal VK, Jenaw RK. Diagnostic Yield of Cartridge-Based Nucleic Acid Amplification Test ( CBNAAT) In Lymph Node Tuberculosis at Institute of Respiratory Disease, SMS Medical College, Jaipur. IOSR J Dent Med Sci. 2019;18:63–7.
  8. INDEX-TB GUIDELINES. Guidelines on extra-pulmonary tuberculosis for India. World Health Organisation; 2016.
  9. Thakur B, Mehrotra R, Nigam JS. Correlation of Various Techniques in Diagnosis of Tuberculous Lymphadenitis on Fine Needle Aspiration Cytology. Pathology Research International. 2013;2013:824620. doi: 10.1155/2013/824620
  10. Mohan CN, Annam V, Gangane N. Efficacy of Fluorescent Method over Conventional ZN Method in Detection of Acid Fast Bacilli among Various Cytomorphological Patterns of Tubercular Lymphadenitis. Int J Sci Res. 2015;4(3):222–5.
  11. Mishra B, Hallur V, Behera B, et al. Evaluation of loop mediated isothermal amplification (LAMP) assay in the diagnosis of tubercular lymphadenitis: A pilot study. Indian J Tuberc. 2018;65(1):76–9. doi: 10.1016/j.ijtb.2017.08.026
  12. Gupta A, Kunder S, Hazra D, et al. Tubercular lymphadenitis in the 21st century: A 5-Year single-center retrospective study from South India. Int J Mycobacteriology. 2021;10(2):162–5. doi: 10.4103/ijmy.ijmy_66_21
  13. Srinivas CV, Nair S. Clinicopathological Profile of Cervical Tubercular Lymphadenitis with Special Reference to Fine Needle Aspiration Cytology. Indian J Otolaryngol Head Neck Surg. 2019;71(Suppl 1):205–11. doi: 10.1007/s12070-017-1235-x
  14. Gangane N, Anshu, Singh R. Role of modified bleach method in staining of acid-fast bacilli in lymph node aspirates. Acta Cytol. 2008;52(3):325–8. doi: 10.1159/000325515
  15. Yew WW, Lee J. Pathogenesis of cervical tuberculous lymphadenitis: pathways to anatomic localization. Tuber Lung Dis. 1995;76(3):275–6. doi: 10.1016/s0962-8479(05)80019-x
  16. Dasgupta S, Chakrabarti S, Sarkar S. Shifting trend of tubercular lymphadenitis over a decade — A study from the eastern region of India. Biomed J. 2017;40(5):284–9. doi: 10.1016/j.bj.2017.08.001
  17. Jamsheed A, Gupta M, Gupta A, et al. Cytomorphological pattern analysis of tubercular lymphandenopathies. Indian J Tuberc. 2020;67(4):495–501. doi: 10.1016/j.ijtb.2020.07.001
  18. Raja R, Sreeramulu PN, Dave P, et al. GeneXpert assay — A cutting-edge tool for rapid tissue diagnosis of tuberculous lymphadenitis. J Clin Tuberc Other Mycobact Dis. 2020;21:100204. doi: 10.1016/j.jctube.2020.100204
  19. Komanapalli SK, Prasad U, Atla B, et al. Role of CB-NAAT in diagnosing extra pulmonary tuberculosis in correlation with FNA in a tertiary care center. Int J Res Med Sci. 2018;6(12):4039–45. doi: 10.18203/2320-6012.ijrms20184904
  20. Sharif N, Ahmed D, Mahmood RT, et al. Comparison of different diagnostic modalities for isolation of Mycobacterium Tuberculosis among suspected tuberculous lymphadenitis patients. Braz J Biol. 2021;83:244311. doi: 10.1590/1519-6984.244311

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2. Fig. 1. Cytomorphological patterns: epithelioid granulomas with Langhans giant cells and caseous necrosis (Giemsa, ×10) (A); only numerous epithelioid cells and granulomas in a reactive background (Giemsa, ×10) (B); caseous necrosis with few epithelioid cells (Giemsa, ×10) (C); caseous necrosis with few epithelioid cells (Giemsa, ×40) (D); caseous necrosis with few lymphocytes and histiocytes, no epithelioid cells (Giemsa, ×10) (E); tubercular abscess showing predominantly neutrophils along with epithelioid cells (Giemsa, ×10) (F)

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