Diagnosis of Tubercular Lymphadenopathy by Fine Needle Aspiration Cytology, Acid-Fast Staining and Mantoux Test

Abstract

Introduction: This study was undertaken to evaluate the role of Ziehl-Neelsen stain (for acid-fastbacilli), and Mantoux test in diagnosing tubercular lymphadenopathy on FNAC.Methods: FNAC was performed on patient with superfi cial lymphadenopathy. Ziehl-Neelsen stainfor acid fast bacilli was done in all cases where cheesy or purulent material was aspirated and smearsshowed granulomatous lymphadenitis. A Mantoux test was also done in these patients. A Mantouxtest was further done in patients of reactive lymphadenopathy where the lymph node size was morethan 1 cm. If the result was positive, a repeat FNAC was performed. When the repeat FNAC showedill-defi ned granulomas, excision biopsy was done.Results: Tubercular lymphadenopathy was seen in 122 (48.2%) cases. Acid- fast bacilli were found in71 (58.1%) cases. Mantoux test was positive in 112 (91.8%) cases. A repeat FNAC was done in sevenof 11 patients where the cytologic features of tuberculosis were not seen but the lymph node size wasmore than 1 cm and Mantoux test was positive. The repeat FNAC showed ill-defi ned granulomaswithout necrosis. Excision biopsy done in these patients diagnosed them as tubercular lymphadenitisin fi ve of the seven cases, the remaining two cases being diagnosed as reactive lymphadenitis.Conclusions: FNAC coupled with Ziehl – Neelsen staining for AFB and Mantoux test improves thediagnostic effi ciency for tubercular lymphadenopathy.Key Words: FNAC, lymphadenopathy, mantoux test, tuberculosis, Ziehl-Neelsen stain