背景:正确诊断结核(TB)淋巴结炎对其治疗和预防至关重要。细针穿刺细胞学(FNAC)是埃塞俄比亚结核病淋巴结炎诊断的主要方法;然而,埃塞俄比亚东部地区尚未评估FNAC的绩效。这项研究旨在评估FNAC和Ziehl-Neelsen(ZN)染色与GeneXpert染色相比在诊断TB淋巴结炎中的表现。
方法:使用FNAC检查了从291例怀疑患有TB淋巴结炎的患者中收集的细针抽吸(FNA)标本,ZN,和GeneXpert诊断结核淋巴结炎。Gene-Xpert被认为是用于比较的参考标准方法。敏感性,特异性,阳性预测值(PPV),负预测值(NPV),使用SPSS版本25确定κ系数。
结果:灵敏度,特异性,PPV,ZN诊断结核淋巴结炎的NPV为73.2%,97.4%,96.2%,分别为80.1%。ZN和GeneXpert之间的一致性较差(Kappa=-0.253)。敏感性,特异性,PPV,FNAC的净现值为83.3%,94.8%,93.5%,分别为86.3%。FNAC和GeneXpert之间有适度的一致性(Kappa=0.785)。
结论:细针穿刺细胞学检查(FNAC)是诊断结核淋巴结炎比ZN更敏感的检查方法。FNAC显示与GeneXpert测定的中等一致性。这项研究建议FNAGeneXpertMTB/RIF测试优先于FNAC来诊断TB淋巴结炎,以避免对涂片阴性的TB淋巴结炎的漏诊。
BACKGROUND: Proper diagnosis of tuberculosis (TB) lymphadenitis is critical for its treatment and prevention. Fine needle aspirate cytology (FNAC) is the mainstay method for the diagnosis of TB lymphadenitis in Ethiopia; however, the performance of FNAC has not been evaluated in the Eastern Region of Ethiopia. This study aimed to evaluate the performance of FNAC and Ziehl-Neelsen (ZN) staining compared with that of GeneXpert for the diagnosis of TB lymphadenitis.
METHODS: Fine needle aspiration (FNA) specimens collected from 291 patients suspected of having TB lymphadenitis were examined using FNAC, ZN, and GeneXpert to diagnose TB lymphadenitis. Gene-Xpert was considered the reference standard method for comparison. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and kappa coefficient were determined using SPSS version 25.
RESULTS: The sensitivity, specificity, PPV, and NPV of ZN for diagnosing TB lymphadenitis were 73.2%, 97.4%, 96.2%, and 80.1% respectively. There was poor agreement between ZN and GeneXpert (Kappa=-0.253). The sensitivity, specificity, PPV, and NPV of FNAC were 83.3%, 94.8%, 93.5%, and 86.3% respectively. There was moderate agreement between the FNAC and GeneXpert (Kappa = 0.785).
CONCLUSIONS: The fine needle aspiration cytology (FNAC) is a more sensitive test for the diagnosis of TB lymphadenitis than ZN. The FNAC showed a moderate agreement with the GeneXpert assay. This study recommends the FNA GeneXpert MTB/RIF test in preference to FNAC for the diagnosis of TB lymphadenitis to avoid a missed diagnosis of smear-negative TB lymphadenitis.