Cervical lymph node TB: diagnostic yield and patient profile

Cervical lymph node TB (CL-TB) is the most prevalent form of extra-pulmonary TB, yet it remains underdiagnosed in endemic settings due to non-specific symptoms and inconsistent diagnostic pathways. We aimed to identify socio-demographic and clinical predictors of CL-TB in patients attending a tertiary hospital in Bangladesh and evaluate the diagnostic yield of available tests.

We conducted this cross-sectional study at Bangladesh Medical University. We screened 3,619 cervical lymphadenitis patients and enrolled 104 with presumptive CL-TB. Lymph node (LN) aspirates were tested using microscopy, cytopathology, GeneXpert, polymerase chain reaction (PCR), and culture. Data were analysed using STATA 15.

Among 104 participants, 52 were confirmed to have CL-TB by either microscopy, cytopathology, GeneXpert, PCR, or culture. Younger age (18-30 years) and purulent aspirate appearance were independently associated with CL-TB. Cytopathology showed the highest diagnostic yield (82.7%), followed by GeneXpert (71.2%) and PCR (67.3%), while microscopy and culture detected <7% of CL-TB cases.

Combinations of cytopathology with GeneXpert or PCR yielded near-perfect CL-TB detection. This was the first study in Bangladesh to utilise LN aspirates directly for PCR alongside cytopathology, GeneXpert, microscopy, and culture, demonstrating a feasible diagnostic approach in high-burden settings like Bangladesh and offering improved detection and reduced delay.