The significance of metastastic disease in the cervical lymph nodes has long been appreciated. The rich lymphatics of the upper aerodigestive tract explained the high incidence of cervical metastasis, occasional bilaterally spread. Even with appropriate treatment, cervical recurrences do occur. Nonetheless, with the resurgence of tuberculosis, the differential of tuberculous cervical lymphadenitis should be excluded. Appropriate modalities should be employed in making the appropriate diagnosis possible.
Aged ; Antitubercular Agents ; therapeutic use ; Female ; Humans ; Lymph Nodes ; microbiology ; pathology ; Tuberculosis, Lymph Node ; diagnosis ; drug therapy

Tuberculosis remains a major public health problem worldwide. A definitive and accurate diagnosis of tuberculosis in cervical lymphadenopathy is important because satisfactory results can be achieved with chemotherapy alone, obviating surgery. Recently, fine needle aspiration cytology (FNAC) has provided an alternative and easy procedure for collection of material for cytomorphologic and bacteriologic examination. But the detection rate for M. tuberculosis from the aspirate material is still low with Ziehl-Neelson stain and even with culture. The authors therefore performed polymerase chain reaction (PCR) for mycobacterial DNA sequences in 31 cases of cytodiagnosis of tuberculous lymphadenitis and compared conventional bacteriologic methods. Ziehl-Neelson staining for acid-fast bacilli (AFB) was positive in 3 cases (10%) in direct smears, and the cultures for M. tuberculosis were positive in 6 cases (19%). In 19 (61%) among 31 samples, mycobacterial DNA fragments were detected, using the PCR method. With combined conventional and PCR method, the rate of detection was increased to 68 percent high. In conclusion, PCR is the most sensitive technique in the demonstration of M. tuberculosis in patient with clinically suspected as tuberculosis, who have AFB stain or culture negative cytology. Combined conventional and PCR methods as well as cytologic findings are of further help in the detection and characterization of M. tuberculosis.
Biopsy, Needle/*methods ; Case-Control Studies ; DNA, Bacterial/*analysis ; Human ; Lymphadenitis/microbiology/*pathology ; Mycobacterium tuberculosis/*isolation & purification ; *Polymerase Chain Reaction ; Sensitivity and Specificity ; Tuberculosis, Lymph Node/microbiology/*pathology