Case Series Report of Tuberculous Lymphadenitis: Role of Coordinator and Sample Handling Protocols for Diagnosis by Fine Needle Aspiration Approach

Abstract

Tuberculous lymphadenitis is manifested by enlarged nodes that mostly affect cervical nodes. Differential diagnosis for lymphadenopathy is diverse. Fine needle aspiration biopsy (FNAB) has been accepted as minimal invasive approach. However, the cytology from FNAB cannot give definitive diagnosis of tuberculosis. Culture, the gold standard diagnostic tool, is limited from small tissue sample and time-consuming. The optimum sample handling protocol is lacking. PCR and Acid-fast stain to detect the microorganism can perform with smears on the cytology slides, sound beneficial. The procedures have not been standardized either. Due to a train of diagnosis tests, a person as patient tests coordinator is merited. The authors therefore reported herewith the cases that underwent our protocol of sample handing and having a coordinator to facilitate the tests done and the results ready on time when the patients had a visit schedule with clinicians. Upon cytology suspected tuberculous lymphadenitis, one smeared slide would re-stained according to routine acid- fast stain method. Another smeared slide would be tested with PCR-based for M. tuberculosis complex. The patients were called for re-FNAB and the samples put directly into a media for culture of M. tuberculosis with automation method. On the patients visited to the clinicians, usually within two weeks, all relevant results – cytology, acid fast stain, PCR were available for the clinicians for treatment or further management plan. The results of culture were accomplished in 4 weeks ready for the clinicians to modify the treatment if indicated. Though all the cases in this report had received a good care and recovered from the diseases, not every case had an uneventful course. The individual clinical course of 10 patients would be present in this case series report. Lastly, aspects of diagnostic challenge were listed and discussed.