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Fine Needle Aspirate and Cytology (FNAC) as Useful Tool in the Diagnosis of Suspected Tuberculous Lymphadenitis in Rwanda, 2009

Uwimana I, Gatabazi JB, Mukabayire O, Bigirimana V, Ngendahayo L, Mubako TVK and Stevens MH

Background: The number of people infected with tuberculosis is gradually increasing in Rwanda. The diagnosis of suspected Tuberculous Lymphadenitis (TL) is still difficult to diagnose and remain expensive when applying surgical procedures.

Objective: To study the usefulness of fine needle aspirates in diagnosis of TL in patients from a low income country.

Methods: Triplicate smears from lymph node aspirates were prepared. Air-dried smears were stained by hot ZN staining technique for AFB examination, and Gram staining technique for exclusion of any bacterial infection and Papanicolaou staining technique was done for cytological to detect malignant cells and other pathology. Slides were examined by laboratory technologist and pathologist respectively.

Results: A total number of 138 specimens from suspected TL patients were analysed, of which 14 (10.1%) were ZN positive while cytology revealed 25 (18.1%) cases of Tuberculous Lymphadenitis. From Papanicolaou stain 25 (18.1%) cases were either supportive for TB (7.2%) cases or suspicious for TB (10.9%) while 113 (81.9%) there was no features for TB. Among 25 cases which were supportive or suspicious for TB only 6 cases (4.3%) were also ZN positive and 19 (13.8%) were ZN negative. Cytology revealed also 19 (13.8%) cases of reactive nodes, 25 (18.1%) accounted for other pathologies and 33 (23.9%) were inadequate samples for analysis and interpretation. Gram stain showed 2 (2.7%) cases of Gram positive cocci.

Conclusion: In low income countries, the use of FNA cytology with more training should be considered as a useful tool in diagnosis of TL instead of biopsy applying surgical procedures.