Rapid Diagnosis of Pediatric Mycobacterial Lymphadenitis Using Fine Needle Aspiration Biopsy
Abstract
BACKGROUND: Diagnosis of tuberculosis in children is challenging and fine needle aspiration biopsy (FNAB) is used worldwide in the diagnosis of palpable masses including peripheral lymphadenopathy. Recent studies of the use of nucleic acid amplification such as the Xpert MTB/RIF test on FNAB in adult patients have shown considerable promise. Xpert MTB/RIF allows for the rapid diagnosis of Mycobacterium tuberculosis and identification of rifampicin susceptibility. Studies to date have been predominantly performed in adults. This study aims to determine the accuracy of Xpert MTB/RIF for the detection of M. tuberculosis complex in FNAB from children with clinically suspected mycobacterial lymphadenitis. METHODS: Prospective hospital-based study of children <13 years referred for FNAB at Tygerberg hospital and Dora Nginza hospital, South Africa, for suspected mycobacterial lymphadenitis. Aspirates were performed and the results of the Xpert MTB/RIF test were compared with liquid (mycobacterial growth indicator tube) culture and cytology. RESULTS: FNABs were collected from 110 children and 38 (35%) cases were excluded. Of the 72 cases included in the study, 32 were positive for M. tuberculosis complex on Xpert MTB/RIF, 36 on cytology and 25 were culture positive for M. tuberculosis complex. Compared with the combined reference standard (cytomorphology suggestive of mycobacterial disease with direct visualization of the organism and/or bacteriological culture), Xpert MTB/RIF identified 32 of 40 cases as positive with a sensitivity and a specificity of 80% and 93.8%, respectively. CONCLUSIONS: FNAB and Xpert MTB/RIF enable a rapid diagnosis in pediatric mycobacterial lymphadenitis, expediting appropriate treatment and potentially preventing morbidity and mortality.
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A hospital-based South African FNAB study in 72 children by Coetzee et al. reported a sensitivity of 80% and a specificity of 93.8% against a composite reference standard.
“A hospital-based South African FNAB study in 72 children by Coetzee et al. reported a sensitivity of 80 % and a specificity of 93.8 % against a CRS (cytology suggestive of mycobacterial disease with visualization of the bacillus and/or positive TB culture) [37].”
From Evaluation of Xpert® MTB/RIF and Ustar EasyNAT™ TB IAD for diagnosis of tuberculous lymphadenitis of children in Tanzania: a prospective descriptive study (2016) · cites this paper as [37]
The limited sensitivity of Xpert MTB/RIF is most likely caused by the paucibacillary nature of lymphatic TB manifestations in children or by suboptimal rinsing of needle passes.
“The limited sensitivity of Xpert MTB/RIF is most likely caused by the paucibacillary nature of lymphatic TB manifestations in children [38] or by suboptimal rinsing of needle passes [37].”
From Evaluation of Xpert® MTB/RIF and Ustar EasyNAT™ TB IAD for diagnosis of tuberculous lymphadenitis of children in Tanzania: a prospective descriptive study (2016) · cites this paper as [37]
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Xpert <sup>®</sup> MTB/RIF assay for extrapulmonary tuberculosis and rifampicin resistance
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“8 % against a CRS (cytology suggestive of mycobacterial disease with visualization of the bacillus and/or positive TB culture) [37].”
Background
- Authors
- Coetzee, L., Nicol, M. P., Jacobson, R., Schubert, P. T., van Helden, P. D., Warren, R. M., & Wright, C. A.
- Affiliations
- National Health Laboratory Service (ZA)
- Stellenbosch University (ZA)
- Corresponding author
- Coetzee, Liezel
- Schubert, Pawel T.
- Wright, Colleen A.
- Venue
- Pediatric Infectious Disease Journal
- Published
- 2014-09
- Volume
- 33
- Issue
- 9
- Pages
- 893-896
- ISSN
- 0891-3668 (ISSN-L)
- OpenAlex
- W2332375766
- Cited by
- 29
- References
- 20
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1 · 2023: 4 · 2022: 2 · 2021: 2 · 2020: 5 · 2019: 4 · 2018: 3 · 2017: 1 · 2016: 3 · 2015: 1
- FWCI
- 1.17
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Pediatric Infectious Disease Journal (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
- Health Sciences › Medicine › Surgery › Diagnosis and treatment of tuberculosis
- Health Sciences › Medicine › Epidemiology › Mycobacterium research and diagnosis
- Keywords
- Mycobacterium tuberculosis complex, Xpert MTB/RIF, fine-needle aspiration, rapid diagnosis, pediatric tuberculosis, diagnostic accuracy, cytology, rifampicin susceptibility
- MeSH terms
- Antitubercular Agents, Child, Child, Preschool, False Negative Reactions, False Positive Reactions, Female, Humans, Infant, Lymph Nodes, Male, Microbial Sensitivity Tests, Mycobacterium tuberculosis, Prospective Studies, Rifampin, Sensitivity and Specificity, Time Factors, Tuberculosis, Lymph Node, Polymerase Chain Reaction, Biopsy, Fine-Needle
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