Diagnosis of Tubercular Lymphadenopathy by Fine Needle Aspiration Cytology, Acid-Fast Staining and Mantoux Test

Abstract

Introduction: This study was undertaken to evaluate the role of Ziehl-Neelsen stain (for acid-fast
bacilli), and Mantoux test in diagnosing tubercular lymphadenopathy on FNAC.
Methods: FNAC was performed on patient with superfi cial lymphadenopathy. Ziehl-Neelsen stain
for acid fast bacilli was done in all cases where cheesy or purulent material was aspirated and smears
showed granulomatous lymphadenitis. A Mantoux test was also done in these patients. A Mantoux
test was further done in patients of reactive lymphadenopathy where the lymph node size was more
than 1 cm. If the result was positive, a repeat FNAC was performed. When the repeat FNAC showed
ill-defi ned granulomas, excision biopsy was done.
Results: Tubercular lymphadenopathy was seen in 122 (48.2%) cases. Acid- fast bacilli were found in
71 (58.1%) cases. Mantoux test was positive in 112 (91.8%) cases. A repeat FNAC was done in seven
of 11 patients where the cytologic features of tuberculosis were not seen but the lymph node size was
more than 1 cm and Mantoux test was positive. The repeat FNAC showed ill-defi ned granulomas
without necrosis. Excision biopsy done in these patients diagnosed them as tubercular lymphadenitis
in fi ve of the seven cases, the remaining two cases being diagnosed as reactive lymphadenitis.
Conclusions: FNAC coupled with Ziehl – Neelsen staining for AFB and Mantoux test improves the
diagnostic effi ciency for tubercular lymphadenopathy.
Key Words: FNAC, lymphadenopathy, mantoux test, tuberculosis, Ziehl-Neelsen stain