Tuberculous lymphadenitis in children--role of fine needle aspiation cytology

Tuberculosis in children remains misdiagnosed, underdiagnosed or paradoxically overtreated as a result of diagnostic difficulties and non-specific manifestations such as lymphadenopathy. The aims of the study were, i) To assess the efficiency of fine needle aspiration cytology (FNAC) in comparison to histology to determine the prevalence of tuberculosis in lymph nodes, ii) To compare the cytological and histopathological features of lymphadenopathy in children to adults, iii) To analyse the clinical significance of the results in the context of diagnosis.

The biopsies of lymph nodes obtained during the seven year period from January 1989 to December 1995 and the lymph nodes on which fine needle aspiration cytology was done during the period, January 1990 to December 1995 were included for the study. Hemotoxylin and Eosin stain was used for basic evaluation of the histopathologic features. A grading system of 0 to 5+ was used to assess the smears to categorise them into diagnostic groups.

Among 1396 lymph node biopsies submitted for evaluation of non-neoplastic conditions 54.12% (741) showed tuberculosis, in which children constituted 9.04%. A higher incidence of 68.61% was observed on FNAC. Both on cytology and histology, a necrotizing type of inflammation was observed more in children, which indicated hypersensitivity.

FNAC was found to be a useful adjunct diagnostic technique especially in children, but the need to develop a sensitive and easily available method to diagnose in asymptomatic and high risk children still persists. Selection of patients with lymphadenopathy for more than three weeks is important, as otherwise nonspecific changes and acute inflammatory changes are likely to interfere with the diagnosis.