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Collection, Isolation, and Flow Cytometric Analysis of Human Endocervical Samples
Published on: July 6, 2014
Indications for open cervical node biopsy in HIV-positive patients
F Burton1, M L Patete, W J Goodwin
1Department of Otolaryngology-Head and Neck Surgery, University of Miami/Jackson Memorial Hospital, FL 33101.
Insights
For human immunodeficiency virus (HIV) patients with non-enlarging cervical lymph nodes, open node biopsy is not recommended. Fine-needle aspiration (FNA) may be useful for diagnosing infections but not neoplastic diseases.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Oncology
Background:
- Historically, open node biopsy diagnosed HIV infection before serologic tests.
- Otolaryngologists manage HIV-positive patients with cervical adenopathy.
- The role of fine-needle aspiration (FNA) versus open biopsy for cervical nodes in HIV patients is unclear.
Purpose of the Study:
- To determine the indications for open cervical node biopsy in HIV-positive patients.
- To evaluate the utility of FNA in diagnosing cervical lymphadenopathy in HIV-positive individuals.
Main Methods:
- Retrospective review of 93 consecutive cervical node biopsies (1985-1989).
- Analysis of 20 HIV-positive patients, including 10 with acquired immune deficiency syndrome (AIDS).
- Comparison of FNA results with open biopsy findings.
Main Results:
- Open biopsy is not indicated for HIV/AIDS patients with nontender, nonenlarging nodes (lymphoid hyperplasia).
- FNA diagnosed mycobacterial infections in 4/8 patients; open biopsy added no value.
- FNA failed to diagnose Nocardial infection (2 patients) and neoplastic diseases (2 patients).
Conclusions:
- Cervical node biopsy is unnecessary for HIV/AIDS patients presenting with nontender, nonenlarging nodes.
- FNA has limitations in diagnosing Nocardial infections and cancers in this population.
- Open biopsy remains crucial for diagnosing certain infections and neoplastic conditions in HIV-positive patients with symptomatic cervical adenopathy.
Abstract:
Open node biopsy was the method of choice for diagnosing human immunodeficiency virus (HIV) infection before serologic testing became available. Currently, the otolaryngologist is often called on to assist in the management of HIV-positive patients with troublesome cervical adenopathy. Today's questions are: what is the place of fine-needle aspiration (FNA), and when is open cervical node biopsy indicated. A retrospective review was undertaken of 93 consecutive cervical node biopsies performed by our department during the 5-year period from 1985 to 1989. Twenty of the patients who underwent biopsy were HIV-positive. Of these twenty, ten carried an established diagnosis of acquired immune deficiency syndrome (AIDS). Seventeen of these patients underwent FNA before biopsy. In the eight patients with persistent generalized lymph-adenopathy (PGL) and nontender, nonenlarging nodes, pathologic analysis revealed lymphoid hyperplasia. Five of these patients had antecedent FNA, none demonstrating any pathologic changes. Of the twelve patients with enlarging or tendon nodes, the diagnosis of mycobacterial adenitis was made in eight, Nocardial infection in two, Burkitt's lymphoma in one, and metastatic Kaposi's sarcoma in one. In four of the patients diagnosed with mycobacterial infections, FNA yielded cytologic evidence of acid-fast bacilli and open lymph node biopsy added nothing. In contrast, FNA failed to reveal the diagnosis in both patients with Nocardial infection, and in the two patients with neoplastic disease. We conclude that cervical node biopsy is not indicated in the HIV or AIDS patient with nontender or nonenlarging nodes.(ABSTRACT TRUNCATED AT 250 WORDS)
