Surgical Lymph Node Biopsy in the Diagnosis of Tuberculous Lymphadenopathy

Abstract

Background: Lymphadenopathy is a common problem in medical practice. Tuberculous lymphadenitis is among the commonest causes of lymphadenopathy in the developing world.Objectives: To describe the clinical presentations and the investigations for the diagnosis of lymphadenopathy. To study cases of tuberculous lymphadenitis with a view to determining the value of clinical and investigative diagnostic indices.Materials & Methods: A prospective observational study was conducted to describe the clinical presentations and the pathological diagnoses resulting from (76) surgical lymph node biopsies in patients (44 male, 32 female) with enlarged lymph nodes admitted to Al-Yarmouk Teaching Hospital in Baghdad (during the period from 1st Jan. 2001 to 31st Dec. 2002).Results: 30 patients out of 76 (39.4%) had Tuberculous Lymphadenitis, while 20 patients (26.3%) had Non-specific lymphadenitis, 12 patients (15.8%) had Lymphoma, 10 patients (13.1%) had Neoplastic metastases, and the rest 4 (5.4%) had other diagnoses like brucellosis & toxoplasmosis.The epidemiological, clinical, and investigative results of 30 patients with tuberculous lymphadenopathy were analyzed. While cervical lymphadenopathy predominated (60%), the classical clinical features of tuburculous infection both local and general were frequently absent. Almost only third of the cases (33.33%) had a normal ESR (< 20mm/hr) and only (30%) had lymphocytosis. A clinical diagnosis of tuberculous lymphadenopathy was accordingly made in only (18) patients (60%).Conclusion: This study emphasizes the need of a high index of diagnostic suspicion of tuberculosis when confronted with peripheral lymphadenopathy in developing countries, and the need of surgical LN biopsy in confirming the diagnosis.