ROLE OF FINE NEEDLE ASPIRATION CYTOLOGY AND ZIEHL NEELSEN STAINING IN DIAGNOSIS OF PATIENTS WITH SUSPECTED TUBERCULOUS LYMPHADENITIS

ABSTRACT
Objective: To determine the role of Fine Needle Aspiration Cytology (FNAC) and Ziehl Neelsen staining in diagnosis
of patients with suspected tuberculous lymphadenitis
Methods: This cross-sectional study was carried out in the department of Pathology, Khyber Medical College Peshawar.
A total of 125 patients clinically suspected of having tuberculosis with well palpable and enlarged cervical lymph node
were included. Fine needle aspiration cytology was performed according to standard protocols. Cytological smears
were examined under microscope using hematoxylin and eosin stain (H and E) for the presence of granuloma, necrosis,
Langhans giant cells, plasma cells, lymphocytes, macrophages, and neutrophils. Smears stained with ZN stain were
examined under oil immersion objective for presence of Acid Fast Bacilli (AFB).
Results: Among 125 cases there were 33% male and 67% female patients with an age range of 1-55 years. Based on
cytomorphological findings, out of total 125 lymph node aspirates, 89% (111/125) cases revealed cytomorphological
features suggestive of tuberculous lymphadenitis. Out of 111 cases showing cytological picture of tuberculous lymphadenitis,
most common cytomorphological pattern in our study was epithelioid granulomas with caseous necrosis in
69% (77/111) of the cases, followed by necrosis only without epithelioid granulomas 19% (21/111) cases and epithelioid
granuloma without necrosis in 12% (13/111) of the cases. Microscopic examination using Ziehl Neelsen stain revealed
AFB positivity in 65% cases (81/125) with high frequency (54%) among cases with caseous necrosis as compared to
cases without necrosis (11%).
Conclusion: Based on our study findings we conclude that in patients presenting with cervical lymphadenopathy
especially in developing countries where tuberculosis is endemic and where advanced diagnostic facilities are not
available, combination of fine needle aspiration cytology and Ziehl Neelsen staining is an alternate, non-invasive and
cost-effective out-patient technique for initial diagnosis of tuberculous patients.
Keywords: FNAC, Tuberculous lymphadenitis, Zeihl Neelsen Stain