Abstract：
BACKGROUND: Extrapulmonary tuberculosis (EPTB) makes for 25% of all instances of tuberculosis (TB) patients. The enigmatic clinical presentation of EPTB makes identification difficult since it simulates other chronic conditions such as neoplastic and inflammatory disorders and could culminate in treatment that is either insufficient or not required. For an affirmative and confirmed diagnosis, a substantial level of suspicion is imperative. The paucibacillary feature of EPTB makes diagnosis extremely difficult and necessitates the use of many diagnostic methods to arrive at a precise diagnosis. In December 2010, the World Health Organization recommended using GeneXpert/cartridge-based nucleic acid amplification test (CBNAAT) for the initial assessment of suspected cases of EPTB. Furthermore, fine-needle aspiration cytology (FNAC), Ziehl-Neelsen (ZN) stain, and the CBNAAT have to be utilized to exclude other possible origins of granulomatous inflammation. The goal of the current investigation is to comprehend how FNAC and ZN stains relate to CBNAAT and their diagnostic value.
METHODS: The evaluation included all suspected instances of tubercular lymphadenopathy, and adequate aspirates were obtained from the site of the enlarged cervical lymph nodes. Smears were made following FNAC and stained with ZN stain as well as hematoxylin and eosin stain. Simultaneously, CBNAAT and culture evaluations were conducted on the same aspirates. This cross-sectional study took place at a tertiary care center and encompassed 200 individuals with clinical manifestations of EPTB.
RESULTS: There were 200 cases of suspected tubercular lymphadenitis (TBLN). According to the FNAC results, TBLN was detected in 71 (47.6%) of these 200 cases, followed by necrotizing lymphadenitis in 56 (37.5%), chronic caseating granulomatous lymphadenitis in 47 (31.5%), and reactive lymphadenitis in 26 (17.4%). They were correlated with CBNAAT results, which showed that all instances of tuberculous lymphadenitis, 85.71% of cases of necrotizing lymphadenitis, 55.32% of cases of chronic caseating granulomatous lymphadenitis, and 2 (7.69%) cases of reactive lymphadenitis were CBNAAT positive.
CONCLUSIONS: CBNAAT should be utilized with FNAC and ZN staining to diagnose EPTB. The CBNAAT assay demonstrated a significant advantage in the identification of previously unidentified FNAC patients. Despite being a simple diagnostic tool, FNAC has a lower specificity and significantly lower precision than CBNAAT in correctly identifying cases of EPTB because it exhibits similar cytomorphological characteristics with lesions that are not associated with TB.
METHODS: The evaluation included all suspected instances of tubercular lymphadenopathy, and adequate aspirates were obtained from the site of the enlarged cervical lymph nodes. Smears were made following FNAC and stained with ZN stain as well as hematoxylin and eosin stain. Simultaneously, CBNAAT and culture evaluations were conducted on the same aspirates. This cross-sectional study took place at a tertiary care center and encompassed 200 individuals with clinical manifestations of EPTB.
RESULTS: There were 200 cases of suspected tubercular lymphadenitis (TBLN). According to the FNAC results, TBLN was detected in 71 (47.6%) of these 200 cases, followed by necrotizing lymphadenitis in 56 (37.5%), chronic caseating granulomatous lymphadenitis in 47 (31.5%), and reactive lymphadenitis in 26 (17.4%). They were correlated with CBNAAT results, which showed that all instances of tuberculous lymphadenitis, 85.71% of cases of necrotizing lymphadenitis, 55.32% of cases of chronic caseating granulomatous lymphadenitis, and 2 (7.69%) cases of reactive lymphadenitis were CBNAAT positive.
CONCLUSIONS: CBNAAT should be utilized with FNAC and ZN staining to diagnose EPTB. The CBNAAT assay demonstrated a significant advantage in the identification of previously unidentified FNAC patients. Despite being a simple diagnostic tool, FNAC has a lower specificity and significantly lower precision than CBNAAT in correctly identifying cases of EPTB because it exhibits similar cytomorphological characteristics with lesions that are not associated with TB.
摘要：
背景：肺外结核（EPTB）占所有结核病（TB）患者的25％。EPTB的神秘临床表现使鉴定变得困难，因为它模拟了其他慢性疾病，例如肿瘤性和炎症性疾病，并且最终可能导致治疗不足或不需要。为了得到肯定和确认的诊断，严重的怀疑是必要的。EPTB的小细菌特征使得诊断极其困难,并且需要使用许多诊断方法来实现精确诊断。2010年12月，世界卫生组织建议使用基于GeneXpert/cartridge的核酸扩增测试（CBNAAT）对EPTB疑似病例进行初步评估。此外，细针穿刺细胞学（FNAC），Ziehl-Neelsen(ZN)染色,和CBNAAT必须用于排除肉芽肿性炎症的其他可能来源。当前调查的目的是了解FNAC和ZN染色与CBNAAT的关系及其诊断价值。
方法：评估包括所有可疑的结核性淋巴结肿大，并从颈部淋巴结肿大的部位获得足够的抽吸物。在FNAC之后进行涂片并用ZN染色剂以及苏木精和曙红染色剂染色。同时,对相同的抽吸物进行CBNAAT和培养物评价。这项横断面研究在三级护理中心进行，涵盖了200名具有EPTB临床表现的个体。
结果：200例疑似结核性淋巴结炎（TBLN）。根据FNAC的结果，这200例中有71例(47.6%)检出TBLN,其次是坏死性淋巴结炎56（37.5％），慢性干酪性肉芽肿性淋巴结炎47例（31.5%），反应性淋巴结炎26例（17.4%）。它们与CBNAAT结果相关，这表明所有结核性淋巴结炎的病例，85.71%的坏死性淋巴结炎病例,55.32%的慢性干酪样肉芽肿性淋巴结炎,2例（7.69％）反应性淋巴结炎CBNAAT阳性。
结论：CBNAAT应结合FNAC和ZN染色诊断EPTB。CBNAAT测定在鉴定先前未鉴定的FNAC患者中显示出显著优势。尽管是一个简单的诊断工具，FNAC在正确识别EPTB病例方面具有比CBNAAT更低的特异性和显著更低的精确度,因为它表现出与不与TB相关的病变相似的细胞形态学特征。
方法：评估包括所有可疑的结核性淋巴结肿大，并从颈部淋巴结肿大的部位获得足够的抽吸物。在FNAC之后进行涂片并用ZN染色剂以及苏木精和曙红染色剂染色。同时,对相同的抽吸物进行CBNAAT和培养物评价。这项横断面研究在三级护理中心进行，涵盖了200名具有EPTB临床表现的个体。
结果：200例疑似结核性淋巴结炎（TBLN）。根据FNAC的结果，这200例中有71例(47.6%)检出TBLN,其次是坏死性淋巴结炎56（37.5％），慢性干酪性肉芽肿性淋巴结炎47例（31.5%），反应性淋巴结炎26例（17.4%）。它们与CBNAAT结果相关，这表明所有结核性淋巴结炎的病例，85.71%的坏死性淋巴结炎病例,55.32%的慢性干酪样肉芽肿性淋巴结炎,2例（7.69％）反应性淋巴结炎CBNAAT阳性。
结论：CBNAAT应结合FNAC和ZN染色诊断EPTB。CBNAAT测定在鉴定先前未鉴定的FNAC患者中显示出显著优势。尽管是一个简单的诊断工具，FNAC在正确识别EPTB病例方面具有比CBNAAT更低的特异性和显著更低的精确度,因为它表现出与不与TB相关的病变相似的细胞形态学特征。
