CRITICAL APPRAISAL



 Utility of CBNAAT, Cytology and Histology in diagnosis of suspected tubercular solid lymph node


Aims and Objectives: 

To asses efficacy of various diagnostic tools for diagnosis of lymph node tuberculosis in solid state (non-caseating stage).


Methods : 

Prospective observational study over a period of 18 months


Inclusion criteria : 

Clinically suspected extra Pulmonary TB

Suspected LNTB patients on ATT


Exclusion criteria : 

HIV positive patients

Fluctuant node 

on ATT

Patients with cheesy / pus on aspiration of node.


Patients : 

82 patients were initially selected out of which 22 patients were excluded from the study as they are under exclusion criteria.

Out of 60 patients 31 ( 51.67%) were tested positive for MTB in CBNAAT of which 2 are Rifampcin Resistant and remaining 29 patients were opted for excisional biopsy. 

Remaining patients after histology had following diagnosis; Tuberculosis in eight, nonspecific reactive hyperplasia in 11, metastasis and lymphoma in four and Non Tubercular Mycobacteria and actinomycosis in one each patient.


9 out of 60 ( 15%) were detected AFB on ZN stain of which all are CBNAAT positive for MTB.


CBNAAT could not diagnose (8/39) 20% of patients with tuberculosis which are diagnosed by histopathology.


CBNAAT diagnosed 22 (70%) cases which were missed by AFB smear & 16 cases missed by cytology.


Cytological findings of tuberculosis -granulomatous inflammation with or without necrosis was looked for and found in 21/60 patients

A peculiar pattern of reactive hyperplasia was found in 26/60 out of which 15 found positive for MTb on Cbnaat or histology.


Cytological finding correlated with final diagnosis (including Tuberculosis and other diagnoses) in 56.67 % (34/60) cases and final diagnosis was different from cytology in 43.33 % (26/60) cases.





Conclusion : 


CBNAAT has 79% sensitivity ( ruling out a disease ) and 100% specificity ( ruling in a disease) in diagnosing Lymphnode Tuberculosis even in adinitis and non caseous stage although yeild is less compared to caseous stage.


https://www.ijirm.org/html-article/12187

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