Analysis of Diagnostic Trends and Challenges of Tuberculous Lymphadenitis: A 5 years study from Resource Poor Region of South India

Abstract

Background: Tuberculosis remains one of the major cause of morbidity and mortality in developing countries like India despite intense health campaigning and Government Programmes. Tuberculous lymphadenitis being the most common extra pulmonary manifestation of tuberculosis the incidence still on higher margin especially in resource poor areas  which often goes unnoticed and remains as a diagnostic challenge to General Pathologists and sometimes even to cytopathologists.

Aims and Objectives: To document the prevalence of tuberculous lymphadenitis among various patient groups from low socio-demographic profileand also to advocate the best method in early and correct diagnosis of tuberculous lymphadenitis to initiate early appropriate treatment.

Materials &Methodology: In the prospective study conducted in SBV University Hospital, Puducherry a total number of 151 cases clinically suspected of tuberculous LN were included and patients with neoplastic lesion were excluded from this study. The lymph node aspirate collected were analysed for tuberculous cytomorphological changes by using routine cytological stains and observations were correlated with results of various ancillary diagnostic procedures.

Results and Observations:  Among 151 cases studied, 120 cases showed tuberculosis indicating high prevalence. 31 aspirates showed classical tuberculous pattern on cytomorphology, correlating well with histopathology (100%), Polymerase chain reaction (PCR) (100%) and culture (92%) respectively. In rest of the 119 cases carrying non tuberculous pattern on cytology, further exploration by ancillary diagnostic procedures revealed up tuberculosis in 79 cases with confirmation by culture, Histopathology and PCR.

CONCLUSION: Our study showed prevalence of tuberculous lymphadenitis is on higher margin especially among low socio-demographic group and cytological procedure in adjunction with ancillary procedures proved to be reliable and helpful to Cytopathologists. PCR procedure could be widely employed by the Government   especially in endemic regions with resource poor diagnostic facilities