The value of wide-needle aspiration in the diagnosis of tuberculous lymphadenitis in Africa

Abstract

Objectives: To evaluate wide-needle (19-gauge) aspiration in the diagnosis of tuberculous lymphadenitis.

Setting: Department of Surgery, University Teaching Hospital, Lusaka, Zambia.

Patients: Three hundred and four patients presenting to one surgeon for diagnostic surgical biopsy of a peripheral lymph node during 1989-1990.

Design: Prospective study in which wide-needle aspiration routinely preceded open surgical biopsy.

Main outcome measures: Histology and mycobacterial culture of the surgically biopsied lymph node; HIV-1 serology; successful aspiration of material, naked-eye appearance of aspirate, presence of acid-fast bacilli and/or microscopic caseation in the aspirate.

Results: One hundred and eighty-eight out of 304 (61.8%) patients had histologically and/or culture-proven tuberculous lymphadenitis, of whom 155 out of 183 (84.7%) tested HIV-1-seropositive. Material was successfully aspirated from 180 out of 188 (95.7%) of patients with proven tuberculous lymphadenitis. Macroscopic caseation, diagnosable on naked-eye examination alone of the aspirate, was present in 49 out of 120 (40.8%) consecutive aspirates from tuberculous nodes. Acid-fast bacilli and/or microscopic caseation were seen in 116 out of 155 (74.8%) aspirates from tuberculous nodes for which smears stained both by Ziehl-Nielsen and haematoxylin & eosin were available.

Conclusions: It is recommended that all patients with suspected tuberculous lymphadenitis in Africa, undergo wide-needle aspiration before surgical biopsy or empirical treatment.

PIP: This study evaluated wide-needle (19-gauge) aspiration in the diagnosis of tuberculous lymphadenitis. 304 patients presenting to 1 surgeon for diagnostic surgical biopsy of a peripheral lymph node during 1989 and 1990 at the Department of Surgery, University Teaching Hospital, Lusaka, Zambia, were involved in this prospective study in which wide-needle aspiration routinely preceded open surgical biopsy. Histology and mycobacterial culture of the surgically biopsied lymph node, HIV-1 serology, successful aspiration of material, naked-eye appearance of aspirate, and presence of acid-fast bacilli and/or microscopic caseation in the aspirate were the main outcome measures. 188 of 304 (61.8%) patients had histologically and/or culture-proven tuberculous lymphadenitis, of whom 155 of 183 (84.7%) tested HIV-1 seropositive. Material was successfully aspirated from 190 of 188 (95.7%) patients with proven tuberculous lymphadenitis. Macroscopic caseation, diagnosable on naked-eye examination alone of the aspirate, was present in 49 of 120 (40.8%) consecutive aspirates from tuberculous nodes. Acid-fast bacilli and/or microscopic caseation were seen in 116 of 155 (74.8%) aspirates from tuberculous nodes for which smears stained by both Ziehl-Nielsen and hematoxylin and eosin were available. It is recommended that all patients with suspected tuberculous lymphadenitis in Africa undergo wide-needle aspiration before surgical biopsy or empirical treatment.