The value of wide-needle aspiration in the diagnosis of tuberculous lymphadenitis in Africa.
OBJECTIVE
To evaluate wide-needle (19-gauge) aspiration in the diagnosis of tuberculous lymphadenitis.


METHODS
Department of Surgery, University Teaching Hospital, Lusaka, Zambia.


METHODS
Three hundred and four patients presenting to one surgeon for diagnostic surgical biopsy of a peripheral lymph node during 1989-1990.


METHODS
Prospective study in which wide-needle aspiration routinely preceded open surgical biopsy.


METHODS
Histology and mycobacterial culture of the surgically biopsied lymph node; HIV-1 serology; successful aspiration of material, naked-eye appearance of aspirate, presence of acid-fast bacilli and/or microscopic caseation in the aspirate.


RESULTS
One hundred and eighty-eight out of 304 (61.8%) patients had histologically and/or culture-proven tuberculous lymphadenitis, of whom 155 out of 183 (84.7%) tested HIV-1-seropositive. Material was successfully aspirated from 180 out of 188 (95.7%) of patients with proven tuberculous lymphadenitis. Macroscopic caseation, diagnosable on naked-eye examination alone of the aspirate, was present in 49 out of 120 (40.8%) consecutive aspirates from tuberculous nodes. Acid-fast bacilli and/or microscopic caseation were seen in 116 out of 155 (74.8%) aspirates from tuberculous nodes for which smears stained both by Ziehl-Nielsen and haematoxylin & eosin were available.


CONCLUSIONS
It is recommended that all patients with suspected tuberculous lymphadenitis in Africa, undergo wide-needle aspiration before surgical biopsy or empirical treatment.
Bem
C
C
Department of Surgery, School of Medicine, University of Zambia, Lusaka.
Patil
P S
PS
Elliott
A M
AM
Namaambo
K M
KM
Bharucha
H
H
Porter
J D
JD
D000293:Adolescent; D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000295:instrumentation; D002648:Child; D002675:Child, Preschool; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009339:Needles; D011446:Prospective Studies; D014388:Tuberculosis, Lymph Node / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D015024:Zambia / Q000453:epidemiology