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Cited by 35Tuberculosis Research and EpidemiologyDiagnosis and treatment of tuberculosisLymphadenopathy Diagnosis and Analysis

Histopathological and microbiological findings and diagnostic performance of GeneXpert in clinically suspected tuberculous lymphadenitis

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Sarfaraz, Samreen, Iftikhar, Sundus, Memon, Yousuf, Zahir, Naila, Hereker, Fivzia Farooq, Salahuddin, Naseem·2018·International Journal of Infectious Diseases
DOI 10.1016/j.ijid.2018.08.020
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Abstract

OBJECTIVES: The primary objective was to determine the association between histopathological and microbiological findings in patients clinically suspected to have tuberculous lymphadenitis. A secondary objective was to assess the diagnostic utility of GeneXpert in lymph node specimens. METHOD: This was a single-centre prospective cohort study, performed in the Infectious Disease Clinic at The Indus Hospital. Three hundred and forty-one adult patients with chronically enlarged, accessible lymph nodes were enrolled after obtaining verbal consent, between February 2013 and April 2016. Tissue specimens were processed for histopathology, acid-fast bacillus (AFB) microscopy, AFB culture, and GeneXpert. Based on these results, anti-tuberculosis therapy (ATT) was prescribed. Clinical characteristics and treatment outcomes were recorded. RESULTS: There were 297 evaluable patients; 74.4% were diagnosed with tuberculous lymphadenitis (TBLA), 6.7% with a malignancy, and 12.8% with reactive nodes. TBLA was diagnosed on suggestive histopathology in 89.6% of cases, followed by GeneXpert (32.6%), mycobacterial culture (26.6%), and AFB smear positivity (12.5%). The sensitivity of GeneXpert was 65.7% when assessed against AFB culture. Drug resistance was displayed by 8.2% of GeneXpert-positive cases and 11.7% of culture-positive cases. The majority of TBLA patients (88.7%) responded favorably to ATT. CONCLUSIONS: In light of laboratory evidence, a quarter of patients suspected of TBLA had an alternative diagnosis, highlighting its importance in avoiding over-treatment and diagnostic delays in malignancy. Although sensitivity is poor, the demonstration of drug resistance by both GeneXpert and AFB culture represents a useful tool to guide treatment.

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  • In lymph node biopsies, Xpert MTB/RIF sensitivity against a composite reference standard in Sarfaraz 2018 was 33% (27 to 40).

    “In lymph node biopsies, Xpert MTB/RIF sensitivity and specificity against a composite reference standard were 33% (27 to 40) and 85% (73 to 93) (Sarfaraz 2018) and 76% (50 to 93) and specificity of 100% (66 to 100) (Zeka 2011) (2 studies; 288 participants); Figure 14.”

    From Xpert MTB/RIF Ultra and Xpert MTB/RIF assays for extrapulmonary tuberculosis and rifampicin resistance in adults (2021) · cites this paper as Sarfaraz 2018

    The Results report 33.2% GeneXpert sensitivity against histopathology suggestive of tuberculosis, and Statistical analysis identifies histopathology as the composite reference standard (pages unavailable). This supports the rounded 33% estimate for lymph node specimens, but our copy does not report the attributed 27–40 interval. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • In lymph node biopsies, Xpert MTB/RIF specificity against a composite reference standard in Sarfaraz 2018 was 85% (73 to 93).

    “In lymph node biopsies, Xpert MTB/RIF sensitivity and specificity against a composite reference standard were 33% (27 to 40) and 85% (73 to 93) (Sarfaraz 2018) and 76% (50 to 93) and specificity of 100% (66 to 100) (Zeka 2011) (2 studies; 288 participants); Figure 14.”

    From Xpert MTB/RIF Ultra and Xpert MTB/RIF assays for extrapulmonary tuberculosis and rifampicin resistance in adults (2021) · cites this paper as Sarfaraz 2018

    The Laboratory methods and Statistical analysis sections say the study tested lymph-node tissue with GeneXpert and compared its specificity with histopathology used as a composite reference standard. The passages retrieved do not report the claimed 85% specificity or its 73–93% interval; the Discussion’s 80.4% specificity uses culture as a different reference standard. (LLM, conf=0.78)

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Research works printed but not linked: 2

  1. Fijten GH, Blijham GH. Unexplained lymphadenopathy in family practice. An evaluation of the probability of malignant causes and the effectiveness of physicians' workup. J Fam Pract 1988;27(4):373-6.
  2. Sen R, Marwah N, Gupta K, Marwah S, Arora R, Jain K. Cytomorphologic patterns in tuberculous lymphadenitis. Indian J Tuberc 1999;46:125-8.

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Authors
Sarfaraz, S., Iftikhar, S., Memon, Y., Zahir, N., Hereker, F. F., & Salahuddin, N.
Affiliations
  • Indus Hospital (PK)
  • Karachi Medical and Dental College (PK)
Corresponding author
Sarfaraz, Samreen
ORCID
Venue
International Journal of Infectious Diseases
Publisher
Elsevier BV
Published
2018-11
Volume
76
Pages
73-81
ISSN
1201-9712 (ISSN-L)
DOI
10.1016/j.ijid.2018.08.020
OpenAlex
W2890437982
Cited by
35
References
38
Citations by year
2026: 3 · 2025: 2 · 2024: 8 · 2023: 5 · 2022: 7 · 2021: 5 · 2020: 3 · 2019: 2
FWCI
1.89
Type
journal article
Language
en
Open access
Licence
Locations
  • International Journal of Infectious Diseases (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
  • Health Sciences › Medicine › Surgery › Diagnosis and treatment of tuberculosis
  • Health Sciences › Medicine › Surgery › Lymphadenopathy Diagnosis and Analysis
Keywords
tuberculous lymphadenitis, GeneXpert, Mycobacterium tuberculosis, mycobacterial culture, histopathology, drug resistance, tuberculosis treatment, diagnostic sensitivity, lymphadenopathy, differential diagnosis of lymphadenopathy
MeSH terms
Adolescent, Adult, DNA, Bacterial, Female, Humans, Male, Middle Aged, Mycobacterium tuberculosis, Prospective Studies, Tuberculosis, Lymph Node, Point-of-Care Systems, Nucleic Acid Amplification Techniques, Young Adult

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