Cervical tuberculous lymphadenitis in the elderly: comparative diagnostic findings

Area of Science:

• Medical diagnostics
• Infectious diseases
• Geriatric medicine

Background:

• Cervical tuberculous lymphadenitis diagnosis typically relies on fine needle aspiration cytology (FNAC) and polymerase chain reaction (PCR) for Mycobacterium tuberculosis.
• These methods are primarily suited for initial tuberculosis infections.
• Reactivation of tuberculosis is considered the predominant cause of cervical tuberculous lymphadenitis in the elderly population.

Purpose of the Study:

• To evaluate the diagnostic efficacy of FNAC, PCR, and blood tests for reactivation-induced cervical tuberculous lymphadenitis in the elderly.
• To compare the diagnostic performance of these methods between reactivation and primary cervical tuberculous lymphadenitis cases.

Main Methods:

• Retrospective analysis of 33 elderly patients with neck lumps who underwent excisional biopsy (2003-2008).
• Comparison of FNAC results with excisional biopsy findings for suspected tuberculous disease.
• Analysis of leukocyte count and C-reactive protein (CRP) levels in cervical tuberculous lymphadenitis versus malignant lymphoma cases.

Main Results:

• Excisional biopsy confirmed nine cases of cervical tuberculous lymphadenitis, but only one was initially suspected via FNAC.
• Three cases of tuberculous lymphadenitis were misdiagnosed as malignant lymphoma during initial assessment.
• No significant differences were observed in leukocyte count or CRP levels between tuberculous lymphadenitis and malignant lymphoma groups.

Conclusions:

• Diagnosing early-stage, reactivation-induced cervical tuberculous lymphadenitis in the elderly is difficult without excisional biopsy.
• FNAC and PCR may have limited utility for reactivation cases compared to primary infections.
• Cervical tuberculous lymphadenitis must be considered in the differential diagnosis for elderly patients presenting with neck lumps.