Utility of repeat fine needle aspiration in acute suppurative lesions. Follow-up of 263 cases.
OBJECTIVE
To determine the clinical value of repeat fine needle aspiration (FNA) as a follow-up strategy in the management of patients in India, clinically suspected of having tuberculosis (TB) but showing a cytologic picture of acute suppuration.


METHODS
Repeat aspirates from 263 patients presenting with lymph node or soft tissue masses were analyzed. The previous FNA of these cases had shown acute inflammatory exudate but no epithelioid granuloma or acid-fast bacilli (AFB).


RESULTS
The repeat FNA helped to detect 55% additional cases of TB within a period of 8 weeks; 67% of them were diagnosed in the second and third weeks. Diagnostic yield rose to 59% after the third FNA. AFB were detected in 34 (13.3%) cases that showed a low bacterial load. In addition, nontubercular lesions, such as epidermal inclusion cyst (4), cysticercosis (3), sialadenitis (2) and metastatic carcinoma (8), were diagnosed.


CONCLUSIONS
All cases showing acute suppuration without granulomas or AFB on the first FNA should be reevaluated by follow-up FNA and staining for AFB. This will enhance the diagnostic yield of tuberculosis in developing countries, where molecular diagnostics are too costly or unavailable. This procedure is cost effective as compared to biopsy and culture. In addition to tuberculosis, many unexpected nontubercular lesions may also be unmasked. Repeat FNA reduces sampling and screening errors, improves sensitivity and helps to study the evolution of epithelioid granulomas.
Kumar
Neeta
N
Pathology Department, Maulana Azad Medical College, Geneva, Switzerland. kumar_neeta@hotmail.com
Jain
Shyama
S
Murthy
N S
NS
D000208:Acute Disease; D000328:Adult; D017677:Age Distribution; D001399:Azure Stains; D044963:Biopsy, Fine-Needle / Q000592:standards; D003581:Cytodiagnosis / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D013048:Specimen Handling / Q000379:methods; D013492:Suppuration / Q000150:complications* / Q000473:pathology*; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis* / Q000473:pathology*; D014388:Tuberculosis, Lymph Node / Q000473:pathology
D001399:Azure Stains