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Diagnosis of Tuberculous Lymphadenitis Using Fine Needle Aspiration Cytology: A Comparison Between Cytomorphology and GeneXpert Mycobacterium Tuberculosis Resistant to Rifampicin (MTB/RIF) Test
Open accessAbstract
NOTICE: THIS ARTICLE HAS BEEN RETRACTED. Background: Diagnosis of tuberculous lymphadenitis is challenging. Fine needle aspiration cytology (FNAC) can provide a diagnosis suggestive of tuberculosis (TB) when there are epithelioid cells with/without caseation necrosis. But epithelioid cells can occur in some other conditions as well. Xpert MTB/RIF test, a relatively newer technique, can detect bacteria specific DNA by polymerase chain reaction (PCR) and can also detect rifampicin resistance. This study was undertaken to see the role of Xpert test in the diagnosis of tuberculous lymphadenitis from fine needle aspiration (FNA) material, in comparison to cytomorphological diagnosis. Methods: It was a cross-sectional study conducted in the Department of Pathology, BSMMU in collaboration with International Centre for Diarrhoeal Disease Research (icddr, b). Study population was clinically suspected cases of tuberculous lymphadenitis patient referred to Pathology Department, BSMMU. Total number of cases is 351. After FNA, cytomorphological diagnosis was done in Pathology Department, Xpert test in Microbiology Department and culture in icddr,b. Results of FNAC and Xpert test were compared. Kappa test was done to calculate percentage of agreement of FNAC and Xpert test with culture. Results: Final analysis was done in 317 cases following exclusion criteria. Sensitivity, specificity, positive predictive value and negative predictive value of FNAC were 79.7%, 48.1%, 31.9% and 88.6%, respectively. Percentage of agreement of FNAC with culture was 0.183 (Kappa test) implying poor agreement. Sensitivity, specificity, positive predictive value and negative predictive value of Xpert were 95.9%, 60.5%, 42.6% and 98% respectively. Percentage of agreement of Xpert test with culture was 0.39 (Kappa test) implying a slight agreement. Conclusions: In this study, sensitivity of Xpert was higher than FNAC. It was helpful in detecting TB in suppurative lymphadenitis where granuloma/caseation was not found. Cytomorphology, on the other hand, can diagnose granulomatous as well as reactive and other disease conditions. If facilities permit, both FNAC and Xpert test would better to be done. Clin Infect Immun. 2019;4(1):6-11 doi: https://doi.org/10.14740/cii77
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The specificity of FNAC in the present study (86.3%) was greater than that reported in Bangladesh (48.1%), Ethiopia (50%) and Egypt (67.2%).
“However, the specificity of FNAC in the present study (86.3%) was greater than that reported in Bangladesh (48.1%) [21], Ethiopia (50%) [22] and Egypt (67.2%) [24].”
From Performance of fine needle aspiration cytology and Ziehl-Neelsen staining technique in the diagnosis of tuberculosis lymphadenitis (2024) · cites this paper as [21]
The sensitivity of ZN in the present study was higher than that reported from Bangladesh (17.6%).
“The sensitivity of ZN in the present study was lower than that reported from Tirupati, India (83.3%) [19] and India(91%) [20], while it was higher than that reported from Bangladesh (17.6%) [21] and Ethiopia (22.9%) [22].”
From Performance of fine needle aspiration cytology and Ziehl-Neelsen staining technique in the diagnosis of tuberculosis lymphadenitis (2024) · cites this paper as [21]
The sensitivity of FNAC in the present study was comparable to that reported in Bangladesh (79.7%).
“The sensitivity of FNAC in the present study was comparable to that reported Ethiopia (81%) [22] and Bangladesh (79.7%) [21] but lower than that reported in Egypt (90.9%) [24].”
From Performance of fine needle aspiration cytology and Ziehl-Neelsen staining technique in the diagnosis of tuberculosis lymphadenitis (2024) · cites this paper as [21]
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Research works printed but not linked: 23
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Kumbi, H., Ali, M. M., & Abate, A. (2024) · BMC Infectious Diseases · doi:10.1186/s12879-024-09554-z · Cited by 7
Atnafu, A., Desta, K., Girma, S., Hailu, D., Assefa, G., Araya, S., Bekele, D., Wassie, L., & Bobosha, K. (2022) · PLoS ONE · doi:10.1371/journal.pone.0265499 · Cited by 6
Metadata
- Authors
- Nur, T.-E., Akther, S., Kamal, M., Shomik, M. S., Mondal, D., & Raza, A. K. M. M.
- Affiliations
- Bangladesh Medical University (BD)
- International Centre for Diarrhoeal Disease Research (BD)
- Venue
- Clinical Infection and Immunity
- Publisher
- Elmer Press, Inc.
- Published
- 2019
- Volume
- 4
- Issue
- 1
- Pages
- 6-11
- ISSN
- 2371-4972 (ISSN-L)
- 2371-4980
- OpenAlex
- W4232494108
- Cited by
- 4
- References
- 0
- Citations by year
- 2025: 1 · 2023: 1 · 2022: 1 · 2021: 1
- FWCI
- 0.38
- Type
- journal article
- Language
- en
- Status
- Retracted
- Update notices
- retraction (2019-10-01)
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- Clinical Infection and Immunity (publishedVersion, cc-by-nc)
- Clinical Infection and Immunity
- Topics
- Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
- Health Sciences › Medicine › Pathology and Forensic Medicine › Lymphadenopathy Diagnosis and Analysis
- Health Sciences › Medicine › Infectious Diseases › Diagnosis and treatment of tuberculosis
- Keywords
- tuberculous lymphadenitis, fine needle aspiration cytology, Xpert MTB/RIF, Mycobacterium tuberculosis, rifampicin resistance, cell morphology, diagnostic method comparison
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