Volume 8, Issue 2, February – 2023 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

To Study the Correlation between Fine

Needle Aspiration Cytology, Smear and
Culture in Tubercular Cervical Lymphadenitis
in Central India Population
Dr. Kuldeep Pratap Patel (Ass. Professor), Dr. Atul Kumar Khare (Ass. Professor), Dr. Jaymhlal Arya (Sr. Resident)

Abstract:- urban hospitals. Simplicity of these techniques (FNAC &

Introduction: Tuberculosis is a specific infectious disease Smear) combined with early availability of results and
caused by bacteria belonging to the "Mycobacterium good diagnostic accuracy warrants their clinical
tuberculosis complex".It presents a great social and application.Missed cytological diagnosis and isolation of
economic problem and is one of the major factors non-tuberculous mycobacteria justify culture studies on
responsible for the high morbidity and mortality in all suspected tuberculous lymphadenitis cases.
India. The incidence of tuberculous cervical
lymphadenopathy now accounts for two third of the I. INTRODUCTION
extra pulmonary tuberculous lymphadenopathy. Most of
these are supposed to be tuberculous in origin because of Tuberculosis is a specific infectious disease caused by
greater incidence of pulmonary tuberculosis in our bacteria belonging to the "Mycobacterium tuberculosis
country. At the same time there are other causes of complex". The complex includes M. tuberculosis, M. bovis,
lymph-adenopathy which are usually misdiagnosed as M. africanum, M. microti, M. fortuitum, M. kansasii and M.
tuberculosis. It has been a common problem for both to scrofulascium. Tuberculosis is one of the commonest
clinicians as well as pathologist from to diagnose diseases remains a world-wide public health problem, even
tuberculosis. today. It presents a great social and economic problem and
is one of the major factors responsible for the high morbidity
Methos and materials: The present work is carried out and mortality in India.
in 100 clinically suspected cases of tuberculous cervical
lymphadenitis attending E.N.T., Surgery, Paediatrics The disease is usually chronic with varying clinical
and Medicine Department of central India institute as an manifestations. The disease primarily affects lungs and
outdoor/indoor patient during the period of one year. causes pulmonary tuberculosis. It can also affect intestine,
Patients with enlarged cervical lymph nodes with a meninges, bones and joints, lymph nodes, skin and other
history suggestive of tuberculosis were included after tissues of the body. Peripheral tuberculous lymphadenitis is
taking an informed consent. the most common form of extrapulmonary tuberculosis,
most commonly affects the cervical lymph node. (32)It is
Results: Study was done on 100 clinically suspected cases widely prevalent particularly in the malnourished,
of tuberculous cervical lymphadenitis, Tuberculosis was undernourished anddebilitated children.
diagnosed in 57% cases by FNAC, smear and culture
together, the maximum incidence of tuberculosis was The incidence of tuberculous cervical
observed in second and third decades, Females were lymphadenopathy now accounts for two third of the extra
more affected (64%) than males with the ratio of 1:2.3. pulmonary tuberculous lymphadenopathy. Most of these are
By FNAC 42% accuracy was obtained, 30% cases were supposed to be tuberculous in origin because of greater
AFB smear positive in our study this rate of incidence is incidence of pulmonary tuberculosis in our country. At the
nearer to other authors. In our culture study, 57 cases same time there are other causes of lymph-adenopathy
were diagnosed as tuberculous and 4 cases as non- which are usually misdiagnosed as tuberculosis.
tuberculous cervical lymphadenitis. Culture positive was Histopathological study requires considerable time and
higher in granulomatous necrotic lesions. Sensitivity, it may complicate after biopsy. Therefore, the need for less
specificity and predictive values of culture study were traumatic and some faster technique (AFB staining, FNAC)
significantly higher than FNAC and smear. These has been felt in this field and fine needle aspiration of
methods of investigation needs considerable experience cervical lymph nodes for cytology, AFB staining and culture
and confidence of a pathologist who perform the could be a possible. (27,33).The Gold Standard for diagnosis
procedure for a better result. When culture was taken as of tuberculous lymphadenitis is the demonstration of
Gold Standard, cytology was found to be more sensitive mycobacteria in biopsy specimen by smear or culture. The
than smear. sensitivity of these conventional methods is, however low
Conclusions: From this study we concluded that Both when the specimen contains only a small number of
FNAC and smear are quick, simple, less traumatic and organisms. Some studies demonstrated the accuracy of these
cost-effective methods and used as a routine conventional bacteriologic methods is less than 50% (9,31).
investigating procedure in OPD of urban and semi-

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Volume 8, Issue 2, February – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Fine needle aspiration avoids the physical and  The needle is then inserted deep into the lymph node
psychological trauma which occasionally encountered after and plunger of syringe is retracted, creating the vacuum
biopsy, general anaesthesia, surgical operation and in the system while the needle is guided in a straight
hospitalization. Fine needle aspiration being a simple line through the lesion. The needle is moved back and
outpatient procedure is well accepted by patients and has forth up to 1-3 mm of depth in all possible directions
practically no complications. The efficacy of FNAC as a while maintaining the negative pressuresufficient, so
diagnostic procedure is already established and it has been that the cells get dislodged from the lymph node and get
found as effective as biopsy, particularly in cases of access into the aspirating needle.
tubercular lymphadenitis. The aim of FNAC is to confirm  The pressure in the syringe isequalized before the
the nature of lesion within 24 hours or less. Cytodiagnosis needle is withdrawn from the lesion. There after needle
by aspiration of cervical lymph nodes was begun by Guthrie along with the syringe is withdrawn from the lesion and
in 1921. brought near the glass slides. The needle is then
removed from the syringe and air is filled in the syringe
Microscopic examination of smear for AFB by Zeihl by withdrawing the plunger backwards. Then, needle is
Neelsen's staining provides only presumptive evidence of again reconnected to the syringe. The material in the
tuberculosis. It was discovered by Ehrlich. About 10,000 needle and syringe is expelled onto the glass slide in a
cells are needed for smear positive result.Both FNAC and single drop at one end of slide.
smear examinations are almost trivial safe, cost effective  The lymph node aspirate is smeared on glass slide by
and faster techniques.Culture is very sensitive for detection using cover slip or another dry slide.
of tubercle bacilli and may be positive with as few as 10-100
 Smear is fixed immediately in methanol for 10 minutes.
bacilli in the sample. Cultures for tubercle bacilli are
Then stain with Giemsa stain or H&E stain. After 10-15
difficult and time consuming.
minutes, stained slides are washed in running tap water.
The study is based on 100 patients with cervical Then dry the smear and mount with cover slip.
lymphadenitis of different age group, rural as well as urban
 Result:
patients irrespective of their social standing and religion
On high power microscopic examination smear shows
selected at random were included in the study
variable number of Epitheloid granuloma, Epitheloid cells,
II. AIMS & OBJECTIVES lymphocytes, macrophages, polymorphs and Langhan's
giant cells against necrotic background.
This prospective cohort study done to evaluate the
incidence of cervical lymphadenitis in tuberculosis in central B. ACID FAST STAIN (ZIEHL NEELSEN'S TECHNIQUE):
India population for one-year periods in 100 patients. The
 Procedure:
aims are-
 -Smear made in the slide from lymph node aspirate.
 To assess the diagnostic role of FNAC, Smear and culture
 -Kinyoun's Carbol Fuchsin solution at 56°C – 10-15
of fine needle aspiration done on clinically suspected
min
cases of tuberculous cervical lymphadenitis.
Or
 To know different clinical presentation of tubercular
 At room temperature- 30 min
cervical lymphadenitis.
 -Heating till steam rose – 5 min
 To know the most affected cervical lymph node group.
 -Then wash with Tap water – 30 sec
 To detect individuals and comparative sensitivity,
specificity and predictive values of each diagnostic  -1% acid alcohol or 20% H₂So4, solution – 8-10 dips
investigations.  -Wash with running tap water – 2-4 min
 -10% methylene blue solution – 1-2 dips
III. MATERIAL AND METHOD  -95% alcohol – 1 min

The present work is carried out in 100 clinically  Result:

suspected cases of tuberculous cervical lymphadenitis Mycobacterium tuberculosis were stained bright red
attending E.N.T., Surgery, Paediatrics and Medicine remaining field was stained blue. Acid fastness because of
Department of central India institute as an outdoor/indoor high content and variety of lipids, fatty acids and higher
patient during the period of one year. Patients with enlarged alcohol found in tubercle bacilli.
cervical lymph node (s) with a history suggestive of
tuberculosis were included after taking an informed consent. C. CULTURE OF MYCOBACTERIA:
Relevant clinical details were recorded. Fine needle
 Procedure:
aspiration was performed aseptically.
 The contaminated material is mixed with 4% NaOH and
A. FINE NEEDLE ASPIRATION: left for 20 min.
 Technique of lymph node aspiration:
Then, it is centrifused and sediment is inoculated on
 The aspiration is done by 20 ml disposable syringe with
slopes of L-J media at37°C under 5% carbon dioxide.
22- gauge needle attached air tightly.
Colonies appear in 2-3 weeks and may be delayed by for 6-8
 The skin is cleaned with an antiseptic spirit swab and
weeks. Culture examined every week for presence of growth
the suspected lymph node is fixed with one hand in a
upto 8 weeks. All the positive cultures were first confirmed
position favourable for aspiration.

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Volume 8, Issue 2, February – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
for their acid fastness and subsequently identified by using  Lowenstein-Jensen's media:
the following criteria and biochemical tests-rate of growth,  It is a solid media, most widely used for routine culture
type of growth niacin test, catalase test (68°C), nitrate for M. tuberculosisand when the material is
reduction test and aryl sulphatase test. contaminated with other organisms.
 It consists of coagulated Hen's egg, mineral salt
 Result: solution, asparaginase andmalachite green. Malachite
Mycobacterium tuberculosis form large, rough and green prevents growth of other bacteria.
orange yellow colonies whereas mycobacterium bovine
produces small, smooth, flat, colourless anddiscrete growth. E. BIOCHEMICAL REACTIONS:
Several biochemical tests have been described for the
 Acid fast stain: identification ofmycobacterial species.
Kinyoun's Carbol Fuchsin Solution;  Niacin Test; Human bacilli form Niacin when grown on
 Basic fuchsin 4 gm an egg medium (L-J Medium). The human bacilli give a
 Phenol crystal (melted) – 20 ml positive reaction, while the bovine type is negative.
 Distilled water - 100 ml  Nitrate Reduction Test: This is positive with M.
tuberculosis and negative with M. bovis. This test is
 Decolourising agent: weakly positive with some atypical mycobacteria like M.
 Acid alcohol solution kansasii and M. fortuitum.
Concentrated hydrochloric acid – 1 ml
 Catalase Test: Most atypical mycobacteria are strongly
70% alcohol - 99 ml
catalase positive while tubercle bacilli are weekly
 20% H-So4 solution. positive in comparison. e.g. M. kansasii, M.
scrofulascium and M. fortuitum.
 Counter Stain:  Peroxidase Test Tubercles bacilli give positive
 Methylene blue solution: peroxidase test but atypical mycobacteria are negative.
Methylene blue:1.4 gm  Aryl Sulphatase Test: This is formed by atypical
95% alcohol; 100 ml mycobacteria only. The organisms are grown in 0.001 M
tripotassium phenolphthalein disulphate. 2N NaOH is
 Giemsa Stain. added drop by drop to the culture. A pink colour
Fixatives: indicates a positive reaction. e.g., M. fortuitum.
95% alcohol, Methanol, Formalin, Air, Heat

D. CULTURE MEDIA:
Different types of culture medias are used for growth of
mycobacterium tuberculosis. Lowenstein Jensen is most
commonly used media.

 Types:
 Solid media (L-J media, Dorset egg media, petragnani
media).
 Blood media (Tarshish media).
 Serum (Loffler's serum slope media, potato and Dubo's
media).

IV. OBSERVATIONS

S. NO. AGE [YEARS] NO. OF NON- NO. OF TOTAL NO OF

TUBERCULAR TUBERCULAR LYMPHADENOPATHY
CERVICAL LYMPH CERVICAL LYMPH
NODES CASE NODE CASES
1 1-10 4 7 11
2 11-20 10 23 33
3 21-30 7 19 26
4 31-40 12 4 16
5 41-50 6 1 7
6 51-60 3 2 5
7 61-70 1 1 2
TOTAL 43 57 100
Table 1: Age Distribution Of The Patients With Cervical Lymph

 Most common affected age group are middle age group.

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ISSN No:-2456-2165
S. NO AGE MALES FEMALE TOTAL
1 1-10 3 8 11
2 11-20 10 23 33
3 21-30 9 17 26
4 31-40 6 10 16
5 41-50 2 5 7
6 51-60 4 1 5
7 61-70 2 0 2
TOTAL 36 64 100
Table 2: Sex Distribution Of Patient With Cervicaln

 Females are more affected than males.

Cervical Lymphadenitis MALE PERCENTASE FEMALE PERCENTASE

Tubercular cervical lymphadenitis (57 cases) 17 29.82% 40 75.44%
Non- tubercular cervical lymphadenitis [43 19 44.19% 24 55.83%
cases]
Table 3: Sex Distribution Of Patient With Tubercular And Non- Tubercular Cervical Lymphadenitis

Symptoms No. of cases Percentage

Painless swelling in neck 100 100
Low grade fever 23 23
Cough 34 34
Loss of appetite 26 26
Loss of weight 32 32
Sore throat 41 41
Common cold 34 34
Sinus formation 1 1
Discharging sinus 1 1
Table 4(A): Presenting Symptoms Of Cases Of Cervical Lymphadenitis

Symptoms No. of cases Percentage

Painless swelling in neck 57 100
Low grade fever 42 73.6
Cough 23 40.3
Loss of appetite 21 36.8
Loss of weight 34 59.6
Sore throat 11 19.3
Common cold 28 49.1
Table 4(B): Presenting Symptoms Of Cases Of Tubercular Cervicallymphadenitis

Most common presenting symptom of cervical lymphadenopathy is painless swelling in neck followed by sore throat while
most common presenting features of tubercular cervical lymphadenitis is painless swelling over neck followed by low grade fever.

Total no. of cases of tubercular Cervical group of lymph nodes No. of cases
cervical lymphadenitis involved
Upper deep cervical [post. Triangle] 51
Submandibular 24
100 Supraclavicular 17
Submental 6
Jugulodiagastric 2
Table 5(A): Group-Wise Distribution Of Cervical Lymph Nodes

Total no. of cases of tubercular Cervical group of lymph nodes No. of cases
cervical lymphadenitis involved
Upper deep cervical [post. Triangle] 33
Submandibular 10
57 Supraclavicular 11
Submental 3
Jugulodiagastric
Table 5(B): Group-Wise Distribution Of The Tubercular Cervical Lymph Nodes

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ISSN No:-2456-2165
 Most common lymph nodes group of neck involved is upper deep cervical followed by submandibular group in cervical
lymphadenitis.

V. INVESTIGATIONS

A. FNAC: On the basis of cytology, cervical lymphadenitis can be divided into two groups, tubercular and non-tubercular.

Major cytological features No. of cases Lymphocytes Giant cells Macrophages

Epitheloid cells granuloma without necrosis 10 8 10 7
Epitheloid cells granuloma with necrosis 31 31 28 30
Necrosis without epitheloid cells granuloma 1 1 1 1
Total 42 40 39 38
Table 6: Correlation of Major Cytologic Features with Presence of Various Cellular Constituents

The most common cytological features were the B. SMEAR EXAMINATION (AFB STAINING)
presence of Epitheloid cells granulomas, Langhan's giant Increase in AFB positivity was noticed in the presence of
cells, lymphocytes, macrophages and necrosis. increasing degree of necrosis. AFB smear was positive in
65.85% of necrotic lesions and 5% of non- necrotic lesions.
The epitheloid cell granulomas were present in 41 A lower rate of positivity was observed with presence of
cases (97.6%), multinucleate giant cells were detected in 39 granulomatous features alone while necrosis was found to be
cases (92.8%) and macrophages weredetected in 38 cases associated with increasing AFB smear positivity (70.97%).
(90.47%). Appreciable lymphoid cells were noticed in 40 The overall AFB smear positivity was 30% (30/100).
cases (95.2%).
C. CULTURE OF MYCOBACTERIA:
The number of cases associated with epithelial cell On Lowenstein Jensen's culture mycobateria were
granuloma and necrosis were 31 (73.8%), without necrosis isolated in 61 cases, of which 57 (93.4%) were identified as
were 10 (23.8%) and only one case was associated with M. tuberculosis and 04 (6.5%) as non- tuberculous
necrosis. mycobacteria. On further speciation of NTM, two were as
M.kansassi, one M.scrofulascium and one M.fortuitum.
Culture positivity was higher in granulomatous necrotic
lesions (87%). The minimum incubation time for isolation
of M. tuberculosis was 21 days and the maximum was 42
days (mean 29 days).

Cytodiagnosis Cytological findings Number Smear Culture Tubercular Non-

positive positive mycobacteria tubercular
mycobacteria
Suggestive of Epitheloid cells granuloma 10 0 0 0 0
tuberculosis without necrosis [group-1]
Epitheloid cells granuloma 31 22 29 2 2
with necrosis [group-2]
Epitheloid cells granuloma 1 0 1 1 0
with necrosis [group-3]
Suppurative Necrosis with neutrophils 9 5 9 7 2
Non-specific 36 3 18 18 0
lymphadenitis
Insufficient aspirates 13 0 4 4 0
Total 100 30 61 57 4
Table 7: Comparision of Cytological and Mycobacterio logical findings

FNAC 42%
Smear 30%
Culture 61%
Table 8: Individual Positivity Rate Of Investigations

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ISSN No:-2456-2165
Species Number Growth Types of growth Niacin Catalase Nitrate Aryl
rate test test reduction test sulphatase test
M. tuberculosis 57 Slow Rough + - + -
M. kansasii 2 Slow Rough - + + -
M. scrofulaceum 1 Slow Smooth - + - -
M. fortuitum 1 Rapid Smooth filamentous/ - + + +
rough filamentous
Table 9: Species identification of mycobacteria

Investigation True positive [a] True negative [d] False positive [b] False negative [c]
Cytology 44 29 12 29
Smear 27 10 3 14
Culture 57 31 4 10
Table 10: True & False Data of Investigations

Tests Sensitivity Specificity PPV NPV

FNAC 60.27 70.73 78.56 50
Smear 65.85 76.91 90 41.6
Culture 85 88.57 93.4 75.6
Table 11: Statistical Comparison of FNAC, Smear and Culture in Diagnosis Tuberculosis

V. DISCUSSION
The usual age at which the disease clinically manifests
Present study comprises 57 cases of tubercular as found out in thepresent study was highest in second and
lymphadenitis based on FNAC, Zichl Neelsen's AFB stain third decades (shown in table I).
and mycobacterial culture technique to assess the diagnostic
value of these investigations.

Tuberculosis is still the commonest cause of

lymphadenopathy in our country where as it is less in
western countries because of:
 Tuberculosis of dairy has almost been eliminated.
 Pasteurisation of milk.
 The wide spread removal of tonsils which removes the
portals ofentry of tubercle bacilli and also reduces the
pyogenic infections to be spread via haematogenous route
(Lester C. W. 1948).

Comparison with other authors is shown in table XI.

Authors Year No. of cases average age of incidence

Lester C. W.1948 72 15 years
J.A. Ross1953 51 27 years
Trivedi & Basu Malik1953 78 11-20 years
R.K. Narang et al. 60 21-30 years
Natraj G. et al. 2002 250 21-30 years

Thus, the findings of our study are in accordance with In our study incidence of tubercular cervical
observation of other lymphadenitis in rural and urban areas were 61.4% and
38.6% respectively. Higher incidence in rural area also
In the present study, only 6 cases were found in below reposted by Radhika S. et al. (1993), Gutpa S.K. et al.
10 years of age. The low incidence could be because of (1993), Patra et al. (1993), Natraj G. et al. (1982).
treatment without prior investigations. But, Patra et al
(1983) and J.P. Singh et al (1989) reported highest incidence In our study most of the patient reported most
of tubercular lymphadenitis in below 10 years of age. commonly with painless swelling in neck, low grade fever,
cough, loss of appetite & weight. Gupta S.K. et al. and
In the present study the sex incidence was found to be Radika et al. (1993), Tarun Dua et al. (1996), Natraj G. et al.
more in females than in males. The male to female ratio of (2002).
tubercular lymphadenitis was found to be 1:2.3. Male to
female ratio reported by some authors, e.g., Natraj G. et al.
2002 (1:1.3), Sunarto Reksoprawipro (1:2.14), R.K. Narang
et al. (4:5).

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Volume 8, Issue 2, February – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
In the study, cases diagnosed as tubercular cervical The overall smear positivity in various reports range
lymphadenitis involved upper deep cervical lymph nodes from 18% to 53%. In comparison, the overall smear
(57.89%), supraclavicular lymph nodes (19.3%), positivity in the present study at 30% was on lower side.
Submandibular lymph nodes (17.54%) and submental lymph This may be due to the fact that we had screened the smears
nodes (5.26%). after acid fast stain and not fluorescent stain.

Tubercular lymphadenopathy frequently occurs in the Each lymph node aspirate samples were inoculated on
neck (57%) and in supraclavicular area (26%) involving 1-3 two slants of L.J. medium at 37°C in presence of CO₂ for at
nodes (Polesky et al, 2005). The posterior triangle lymph least eight weeks. Each culturewas examined every day for
node was involved in 59.4% cases, anterior triangle lymph the first week and then weekly thereafter. All the positive
node in 21.9% cases and more than one triangle in 18.75% cultures were first confirmed for their acid fastness and
cases (Mervyn Deitel, Toronto). subsequently identified by using the following criteria: Rate
of growth, Type of growth, Niacin test, Catalase test, Nitrate
Cytodiagnosis of tuberculous lymphadenitis is usually reduction test and Aryl sulphatase test. In the present study
based upon demonstration of epitheloid cells and Langhan's there is strong suggestion that the three cytological groups
giant cells in smear (Koss L.G., 1979). However, epitheloid differed from each other.
granuloma can be seen in nontuberculous lesions and
occasionally in malignancies (Christ and Feltes Kennedy, There is increase in culture positivity from zero
1982). percent in those with granuloma alone to 93.5% when
necrosis was associated with granuloma and to 100% when
Presence of epitheloid cells is the first step in necrosis alone was seen (Tarun Dua et al, 1996; Natraj G. et
establishing a diagnosis while morphological, al, 2002). Similar opinion has also been put forward by
microbiological and clinical features can be of additional others probably due to the fact that the central necrotic
help (Lucas, 1955). Even in the absence of epitheloid cells portion of tubercle contains more bacilli.
and giant cells, necrotic material is proved to be useful as it
yields the highest positivity of acid-fast bacilli (Rajwanshi et In our study, mycobateria were isolated in 61 cases of
al, 1987). which 57 (93.44%) were identified as M.tuberclusis and 04
(6.56%) were non-tuberculous mycobacteria.
We have made an attempt to evaluate the role of
various cell types in tuberculous lymphadenitis assessing The prevalence of NTM in our study was 6.56% but
their presence or absence in different smear pattern M.tuberculosis still appears as the most common causative
(epitheloid cells with or without giant cells and with or agent of lymphadenitis. Finding also seen in other studies
without necrosis) and by correlating these with smear and done on NTM in India e..g Ramnathan et al. (1999) isolated
culture positivity. with a rate of 5.26%; (2002) 3.85% and Vibha Talwar et al.
(1990) 21%.
The cytological features which are specific for
tubercular lymphadenitis are caseous necrosis, epitheloid Prevalence of mycobacterium tuberculosis in the study
cells and multinucleated giant cells. In places where of various authors are: Natraj G. et al. (2002) 50%, Polesky
mycobaterial infections are prevalent and other et al. (2005) 62%, Vibha Talwar et al. (1990) 30%.
granulomatous diseases are uncommon, diagnosis of
tuberculosis can be made confidently when the above VI. SUMMARY & CONCLUSION
features are present. In the present study epitheloid cells,
multinucleated giant cells, lymphocytes and macrophages Study was done on 100 clinically suspected cases of
were in 97.6%, 92.8%, 95.2% & 90.47% in cytology of tuberculous cervical lymphadenitis.
aspirates from tuberculous lymph nodes and absceses  Tuberculosis was diagnosed in 57% cases by FNAC,
respectively. FNAC have an important role in diagnosis of smear and culture together.
tuberculosis of lymph nodes.  The maximum incidence of tuberculosis was observed in
second and third decades.
In our study 42% cases were diagnosed as tubercular  Females were more affected (64%) than males with the
lymphadenitis by FNAC. This percent of accuracy is quite ratio of 1:2.3
nearer to the various authors c.g. Rajwanshi et al. (1987)  By FNAC 42% accuracy was obtained, which is
46.6%), Metre and Jayram (1987) 49.8%), Radhika et al. comparable to the accuracy found by the other authors.
(1989), 23.58%, Vibha Talwar et al. (1990) 54%, Natraj G.  30% cases were AFB smear positive in our study this rate
et al. (2002) 53.20%. of incidence isnearer to other authors.
 AFB smear was more positive in necrotic lesions.
In the present study, the rate of AFB positivity was  Both FNAC and smear are quick, simple, less traumatic
30%, which is nearer in accuracy with various authors e.g.,
and cost-effectivemethods.
Lucas (1955) 18%, Krishnaswamy (1975) 25%, Lau et al.
 Both FNAC and smear can be used as a routine
(1988) 53%, Vibha Talwar et al. (1990) 40%, Gupta S.K. et
investigating procedure in OPD of urban and semi-urban
al. (1993) 25%, Radhika S. et al. (1993) 45%, Tarun Dua et
hospitals.
al. (1996) 27.11%, Natraj et al. (2002) 49.4%.

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Volume 8, Issue 2, February – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
 Simplicity of these techniques (FNAC & Smear) [12.] Kuhn C. and Askin FB. (1985) In Andersen's
combined with early availability of results and good Pathology Ed. By J.M Kissure, the CV Mosby Co. St.
diagnostic accuracy warrants their clinical application. Louis Toronto-Princeion P. 852-860
 In our culture study, 57 cases were diagnosed as [13.] Kumar R. et al. (1976): Characterization of Atypical
tuberculous and 4 cases as non-tuberculous cervical mycobacterium strains isolated from cases of
lymphadenitis. pulmonary tuberculosis. Ind. J. Pathol. Microbiol.
 Culture positive was higher in granulomatous necrotic 19:109.
lesions. [14.] Kushner et al. (1957): Amer. Rev. Tuber Vol. 76:
 Sensitivity, specificity and predictive values of culture 108. 52.
study was significantly higher than FNAC and smear. [15.] Lal MM et al. (1972) Role of Anonymous
 These methods of investigation need considerable mycobacteria in pathogenesis ofhuman tuberculosis.
experience and confidence of a pathologist who perform Ind. J. Tuber 19:101.
the procedure for a better result. When culture was taken [16.] Lau S.K. et al. (1990): Efficacy of line needle
as Gold Standard, cytology was found to be moresensitive aspiration cytology in the diagnosis of tuberculous
than smear. cervical Lymphadenopathy. Journal of Laryngology
 Missed cytological diagnosis and isolation of non- and Otology Vol. 104: 24-27, 548
tuberculous mycobacteria justify culture studies on all [17.] Lester CW. (1956): Lymph node tuberculosis in neck
suspected tuberculous lymphadenitis cases. axilla and groin. Amer.Rev. Pulm. Dis., 73.229.
[18.] Lester C.W. (1959): Tuberculous lymphadenitis in
REFERENCES accessible nodes. Arch. Paed 76: 189 59.
[19.] Amer Jr. Dis. Child 101, 756. logani K. et al. (1972):
[1.] Aggarwal P. Wali JP, Singh S, Handa R, Wig N. Study of lymphadenopathies in Himachal Pradesh
Biswas A. A clinico- bacteriological study of Him. J. Med. Edn & Res. 18
peripheral tuberculous lymphadenitis. J Assoc [20.] Mac Kellar A. (1976) Diagnosis and Management of
Physicians India 2001; 49 808-12. Albutt T.C. and Atypical myobacterial lymphadenitis in children J.
Teale T. (185) Clinical lectures Quoted by Bailey H. Pediatric Surg. 11: 85-89.
(1948). [21.] Martin H.E and Elis E.B. (1934): Aspiration biopsy.
[2.] Brueggar H. (1951) Abstract I surgery. Gyna. Obst. Surg Gyne. & Obst.Vol. 59, 573-589
93; 500. Campbell LA. et al. (1977): Lymph node [22.] Martin H.E. and Ellis E.B. (1934): Aspiration biopsy.
tuberculosis A comparison ofvarious methods of Surg Gyne & Obst. 65Vol. 59: 573-589
treatment. Tubercle 58:171-179. [23.] Meena Sadanah Metre (1987): Acid fast bacilli in
[3.] Chandrasekhar S. (1973) Bacteriological and cultural aspiration smear fromtubercular lymph nodes. Acta
studies on atypical mycobacteria isolated from Cytological. Vol. 31:17.
patients with chronic non tuberculous respiratory [24.] Mervyn Deitel, Toronto, Canada: Modern
diseases. Ind. J. Dis. Chest. 15: 189 18 management of scrofula, 1970-1984 Meter M.S. and
[4.] Dahlgren S.E. and Ekstrom P. (1972): Aspiration Jayram G. (1987): Acid fast bacilli in aspiration
cytology in diagnosis ofpulmonary tuberculosis. smears from 68tuberculous lymph nodes an analysis
Scand J. Respir Dis. Vol. 53:196-201 of 225 cases. Acta cytol. 31:17-19.
[5.] Dandapat, M.C., Panda, B.K., Patra, A.K. and [25.] Morrison M. et al. (1952): Lymph node aspiration
Acharya, N. Diagnosis of tubercular lymphadenitis by Am. J. Clin Pathol vol. 22 255-262
fine needle aspiration cytology, Ind. J. Tub.. 1987, 34, [26.] Nagpal, B.L. Dhar, C.N., Singh, A. and Bahi, H.H.
139. 22. Evaluation of imprint cyrodiagnosis in case of
[6.] Das D.K. et al. (1990): Tuberculous lymphadenitis lymphadenopathy. Ind. J. P.M.; 1982, 25, 35. 74.
correlation of cellular components and Necrosis in [27.] Natraj G. Kurup S, Pandit A., Mehta P. Seth G.S.
lymph node aspirate with A.F.B. Positivity and Medical College and KEMHospitsal, Parel Mumbai,
Bacillary count Indian J. Pathol. Microbiol 33(1), 1- India. Correlation of Fine Needle aspiration cytology,
10. smear and culture in tuberculous lymphadenitis.
[7.] Gopinathan V.P. Tuberculosis in the Indian scene: (2002).
From the clinician’sangle. [28.] Pamra. S.P., and Mathur, G.P. A Co-operative study
[8.] J. Assoc. Physicians India 1989; 37: 525-8. of tuberculous cervical lymphadenitis Ind. J. Med.
[9.] Gupta S.K. et al. (1975): Evaluation of fine needle Res., 1974, 62, 1631
aspiration biopsy technique in the diagnosis of [29.] Patra A.K. et al. (1983): Diagnosis of
tumors. Ind. J. of Cancer Vol. 12; 257-267 lymphadenopathy by fine needle aspiration cytology.
[10.] Krishanswami H. et al (1972): Tuberculous Ind. J. Pathol. Microbiol. 26: 273-278. P. 147-, 1948.
lymphadenitis in South India. A histological and [30.] R.K. Narang, S. Pradhan, R.P. Singh and S.
bacteriological study. Tubercle 53:215-220. Chaturvedi: Place of FNAC in the diagnosis of
[11.] Kubica G.P. (1973) Differential identification of lymphadenopathy.
mycobacterium VII key features for identification of [31.] Radhika S. et al. (1989) Role of culture for
clinically significant mycobacteria. Am. Rev. Resp. mycobacteria in fine needle aspiration diagnosis of
Dis. 107-109. tuberculous lymphadenitis. Diagn Cytopathol. 5 (3):
260-262.

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[32.] Rajwanshi V.S. and Tiyagi G.K. (1970): A typical
mycobacteria in humandisease. Review of literature
with report of five strains isolated from cases
ofpulmonary tuberculosis. Ind. J. Pathol. Bacteriol.
Vol. 13: 21.
[33.] Ramanathan VD, Janaki MS. Paramasivan CN,
Rajaram K, ChandrasekharK. Kumar V, et al. A
histologic spectrum of host responses in
tuberculouslymphadenitis Indian J. Med. Things.
1999; 109: 212-20.
[34.] Saha A. et al. (1986) Fine needle aspiration in the
diagnosis of cervical lymphadenopathy. Am. J. of
Surgery vol. 152; 420-423.
[35.] Singh J.P. et al. (1989) Role of fine needle aaspiration
cytology in the diagnosis of tubercular lymphadenitis.
I.J. P & M Vol. :115-8
[36.] Tarun Dua, P. Ahmed, S. Vasenwala, F. Beg and A.
Malik: Correlation of cytomorphology with AFB
positivity by smear and culture in tuberculous
lymphadenitis. 1996.
[37.] Thompson B.C. (1936): British Med. Jour. 2; 584. 16.
Tide A. Kline (1976): Needle aspiration biopsy
diagnosis of subcutaneousnodule and lymph node.
JAMA 235 (26): 2848-2850. 17.
[38.] Trivedi B.P. and Basu Mallick C.K. (1953): Lymph
node biopsy. IndianJournal of Surg. Vol. 15: 72-74.

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