Reactive Lymphoid Hyperplasia or Tubercular Lymphadenitis: Can Real-Time PCR on Fine-Needle Aspirates Help Physicians in Concluding the Diagnosis?

2018 ◽  
Vol 62 (3) ◽  
pp. 204-208 ◽  
Author(s):  
Vivek Gupta ◽  
Arvind Bhake
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Real Time ◽  
Predictive Value ◽  
Lymphoid Hyperplasia ◽  
Reactive Lymphoid Hyperplasia ◽  
Rt Pcr ◽  
Likelihood Ratios ◽  
Diagnostic Challenge ◽  
Cross Sectional

Background: Enlarged lymph nodes in adult patients often present a diagnostic challenge. In the absence of granuloma or necrosis, the cytology/tissue findings are misleading and relate the enlarged lymph nodes to reactive lymphoid hyperplasia (RLH), because granuloma formation is an immunological response that usually takes 14–100 days to develop. This study assesses the role of real-time (RT)-PCR in the diagnosis of the Mycobacterium complex (MTBC) in lymph node aspirates compared with culture in cases of RLH. Methods: A cross-sectional study was conducted on 112 patients, aged 15–74 years, with a diagnosis of RLH on cytology. RT-PCR for MTBC detection and culture on Löwenstein-Jensen medium for tubercular bacilli was done on lymph node aspirates. Comparative values with reference to culture were calculated. The χ2 value, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios (LR) were calculated. Results: Out of 112 RLH cases, 35 (31%) were positive on both RT-PCR and culture. RT-PCR was positive in 43 cases and culture was positive in 44 cases. The χ2 test was found to be highly significant. PPV, NPV, positive LR, and negative LR were 81.4%, 87%, 6.76, and 0.23, respectively. Conclusion: RT-PCR for MTBC proves to be useful in arriving at a conclusive diagnosis in patients with a cytological diagnosis of RLH.

Assessment of Clinically Suspected Tubercular Lymphadenopathy by Real-Time PCR Compared to Non-Molecular Methods on Lymph Node Aspirates

2017 ◽  
Vol 62 (1) ◽  
pp. 4-11 ◽  
Author(s):  
Vivek Gupta ◽  
Arvind Bhake
Keyword(s):  
Real Time ◽  
Real Time Pcr ◽  
Cross Sectional Study ◽  
Lymphoid Hyperplasia ◽  
Reactive Lymphoid Hyperplasia ◽  
Diagnostic Modality ◽  
Cross Sectional ◽  
Microbiological Methods ◽  
Necrotizing Granuloma ◽  
Tubercular Lymphadenitis

Background: The diagnosis of tubercular lymphadenitis (TBLN) is challenging. This study assesses the role of diagnostic intervention with real-time PCR in clinically suspected tubercular lymphadenopathy in relation to cytology and microbiological methods. Methods: The cross-sectional study involved 214 patients, and PCR, cytology, and Ziehl-Neelsen (ZN) staining was performed on aspirates. The findings were compared with culture on Lowenstein-Jensen medium. The overall concordance of cytology and PCR, both individually and combined, was calculated. χ2 and Phi values were assessed between cytology, PCR, and culture. Results: A cytological diagnosis of tuberculosis (TB), reactive lymphoid hyperplasia, and suppurative lymphadenitis was made in 71, 112, and 6 patients, respectively. PCR and culture were positive in 40% of the cases. Among the TBLN patients, PCR showed higher positivity in necrosis and culture showed higher positivity in necrotizing granuloma. Positive ZN staining was observed in 29.6% of the TBLN cases, with an overall positivity of 11%. PCR could additionally detect 82 cases missed by ZN staining. The overall concordance rate for either diagnostic modality, i.e., PCR or cytology, was highest (75%), and for PCR alone was 74%. Phi values were observed to be 0.47 between PCR and culture. Conclusion: Real-time PCR for Mycobacterium tuberculosis complex on aspirates offers a definitive and comparable diagnosis of TBLN. Including this approach as the primary investigation in the work-up of TBLN could reduce the burden of TB.

scholarly journals Evaluation of Ultrasonography and Colour Doppler in Cervical Lymphadenopathy Taking Histopathology as Comparison

2021 ◽  
Vol 10 (19) ◽  
pp. 1391-1397
Author(s):  
Prinson George ◽  
Aria Jyothi Appukuttan
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Sensitivity And Specificity ◽  
Predictive Value ◽  
Imaging Modality ◽  
Cervical Lymphadenopathy ◽  
Colour Doppler ◽  
Likelihood Ratios ◽  
Cervical Lymph Nodes ◽  
Grey Scale

BACKGROUND Grey scale ultrasonography can be used as a first line imaging modality along with histopathology for evaluation of cervical lymphadenopathy. Morphologic features like size, shape, hilum and necrosis within the lymph node and vascularity are analysed. We wanted to identify the role of Grey scale ultrasonography and colour Doppler in characterisation of enlarged cervical lymph nodes, evaluate findings in benign and malignant cervical lymphadenopathy and assess the sensitivity, specificity, predictive value, likelihood ratios and accuracy in malignant and benign cervical lymph node enlargement. METHODS This was a cross sectional study with diagnostic test evaluation. All suspected cases of cervical lymphadenopathy referred for sonological evaluation to the Department of Radiodiagnosis of Govt. T.D. Medical College, Alappuzha were included in the study. About 75 patients included in the study, underwent Grey scale and colour Doppler sonography of cervical lymphadenopathy. RESULTS When three criteria were positive for malignancy, the sensitivity and specificity of grey scale ultrasonography and colour Doppler were 100 % and 73.80 %, and when four criteria were positive, the sensitivity and specificity were 72.73 %, and 90.48 % respectively. When we analysed individual variables, status of hilum (absence / presence) has reasonably good sensitivity and specificity, positive predictive value, negative predictive value and accuracy (90.09 %, 92.90 %, 90.09 %, 92.90 % and 92.0 % respectively). In our study the important criteria positive for malignant lymph nodes were size > / 11 mm in short axis diameter, round shape, absent hilum and peripheral and central + peripheral type of vascularity of cervical lymph nodes. For benign lymph nodes, oval shape, presence of hilum and central vascularity were the important criteria noted. CONCLUSIONS Grey scale ultrasonography can be complemented by colour Doppler ultrasonography (USG) in patients presenting with cervical lymphadenopathy to differentiate between benign and malignant lesions by reducing unnecessary biopsies by more accurate discrimination. KEY WORDS Grey Scale Ultrasonography, Malignant, Benign Lymph Nodes, Histopathology

Molecular Diagnosis of Tubercular Lymphadenopathy from Fine-Needle Aspirates in Pediatric Patients

2017 ◽  
Vol 61 (3) ◽  
pp. 173-178 ◽  
Author(s):  
Vivek Gupta ◽  
Arvind Bhake
Keyword(s):  
Real Time ◽  
Sensitivity And Specificity ◽  
Real Time Pcr ◽  
Pediatric Patients ◽  
Strong Association ◽  
Immunological Response ◽  
Lymphoid Hyperplasia ◽  
Reactive Lymphoid Hyperplasia ◽  
Cross Sectional ◽  
Fine Needle

Objectives: The diagnosis of peripheral tubercular lymphadenopathy (TBLN) in pediatric patients is often a challenge because features evident on fine-needle aspiration cytology (FNAC) or tissue biopsy can be deceptive for the reason that they result from an immunological response. This study aimed to evaluate polymerase chain reaction (PCR) for Mycobacterium tuberculosis complex (MTBC) in pediatric patients under clinical suspicion for TBLN and to assess its role in the evaluation of cases cytodiagnosed as reactive lymphoid hyperplasia. Methods: This was a cross-sectional study conducted on 45 pediatric patients clinically suspected and unsuspected for TBLN. FNAC, culture on Löwenstein-Jensen medium, and real-time PCR were performed. Comparative values with reference to the culture were calculated. Results: Cytology had a sensitivity and specificity of 38.5 and 87.5%, respectively. Real-time PCR had a sensitivity and specificity of 84.6 and 81.3%, respectively. Of the 32 cases with a cytodiagnosis of reactive lymphoid hyperplasia, 53% were positive both on PCR and culture for M. tuberculosis; the φ value of 0.93 demonstrated a strong association between these 2 methods. Conclusion: Real-time PCR is useful in detecting MTBC in pediatric patients, and it also helps in the diagnosis of cases missed on FNAC.

Role of Clinical Palpation in Evaluation of Cervical Lymph Node in Oral Squamous Cell Carcinoma

2013 ◽  
Vol 1 (2) ◽  
pp. 02-06
Author(s):  
SM Anwar Sadat ◽  
Sufia Nasrin Rita ◽  
Shoma Banik ◽  
Md Nazmul Hasan Khandker ◽  
Md Mahfuz Hossain ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Lymph Node ◽  
Oral Squamous Cell Carcinoma ◽  
Lymph Nodes ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Predictive Value ◽  
Cervical Lymph Node ◽  
Betel Quid ◽  
Cervical Lymph Nodes

A cross sectional study of 29 cases of oral squamous cell carcinoma with or without  cervical lymph node metastasis was done among Bangladeshi patients from January 2006 to December 2007. Majority of the study subjects (34.5%) belonged to the age group of 40-49 years. 58.6% of the study subjects were male, while remaining 41.4% of them were female. 51.7% of the lesions were located in the alveolar ridge where the other common sites were buccal mucosa (27.6%) and retro molar area (13.8%). Half of the study subjects (51.7%) were habituated to betel quid chewing followed by 37.9% and 10.3% were habituated to smoking and betel quid-smoking respectively. Grade I lesions was most prevalent (75.9%) in the study subjects.  Majority of cases presented with Stage IV lesions (55.2%). The sensitivity, specificity, positive predictive value, negative predictive value & accuracy of clinical palpation method for determining metastatic cervical lymph nodes were 93.33%, 64.29%, 73.68%, 90% and 79.3% respectively. Careful and repeated clinical palpation plays important role in evaluation of cervical lymph nodes though several modern techniques may help additionally in the management of oral cancer.DOI: http://dx.doi.org/10.3329/updcj.v1i2.13978 Update Dent. Coll. j. 2011: 1(2): 02-06

N-Staging in Large Cell Neuroendocrine Carcinoma of the Lung: Diagnostic Value of FDG PET/CT Compared to the Histopathology Reference Standard

2021 ◽  
Author(s):  
Hubertus Hautzel ◽  
Yazan Alnajdawi ◽  
Wolfgang P Fendler ◽  
Christoph Rischpler ◽  
Kaid Darwiche ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Predictive Value ◽  
Fdg Pet ◽  
Interrater Reliability ◽  
Glucose Turnover ◽  
Glucose Transporter 1 ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
N Staging

Abstract Background:Large cell neuroendocrine carcinomas of the lung (LCNEC) is a rare entity occurring in less than 4% of all lung cancers. Due to its low differentiation and high glucose transporter 1 (GLUT1) expression LCNEC demonstrates an increased glucose turnover. Thus, PET/CT with 2-[18F]-fluoro-deoxyglucose (FDG) is suitable for LCNEC staging. Surgery with curative intent is the treatment of choice in early stage LCNEC. Prerequisite for this is correct lymph node staging. This study aimed at evaluating the diagnostic performance of FDG PET/CT validated by histopathology following surgical resection or mediastinoscopy. N-staging interrater-reliability was assessed to test for robustness of the FDG PET/CT findings.Methods:Between 03/2014 and 12/2020 46 patients with LCNEC were included in this single center retrospective analysis. All underwent FDG PET/CT for pre-operative staging and subsequently either surgery (n=38) or mediastinoscopy (n=8). Regarding the lymph node involvement, sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were calculated for FDG PET/CT using the final histopathological N-staging (pN0 to pN3) as reference.Results:Per patient 14 ± 7 (range 4 - 32) lymph nodes were resected and histologically processed. 31/46 patients had no LCNEC spread into the lymph nodes. In 8/46 patients final stage was pN1, in 5/46 pN2 and in 2/46 pN3. FDG PET/CT diagnosed lymph node metastasis of LCNEC with a sensitivity of 93%, a specificity of 87%, an accuracy of 89%, a PPV of 78% and a NPV of 96%. Interrater-reliability was high with a strong level of agreement (κ=0.82).Conclusions:In LCNEC N-staging with FDG PET/CT demonstrates both high sensitivity and specificity, an excellent NPV but a slightly reduced PPV. Accordingly, preoperative invasive mediastinal staging may be omitted in cases with cN0 disease by FDG PET/CT. In FDG PET/CT cN1-cN3 stages histological confirmation is warranted, particularly in case of only moderate FDG uptake.

Role of Covid Antigen in the Diagnosis of Covid Positive in Obstetric Patients

2021 ◽  
Vol 15 (10) ◽  
pp. 3356-3358
Author(s):  
Ambreen Fatima ◽  
Nidda Yaseen ◽  
Amna Fareed ◽  
Kashif Ali Samin ◽  
Shumaela Kanwal ◽  
...  
Keyword(s):  
Nucleic Acid ◽  
Early Detection ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
False Negative ◽  
Nucleic Acid Amplification ◽  
Antigen Test ◽  
Rt Pcr ◽  
Cross Sectional ◽  
Specificity And Sensitivity

Background and Aim: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rapid emergence postured significant challenges on the health system in recent years. The early detection of cases is thought to be critical in preventing this pandemic by coronavirus disease (COVID-19), especially important in the obstetrical population due to theirs numerous interactions with another parturient when hospitalized for delivery. Therefore, the present study aimed to assess the COVID antigen test performance in COVID-positive obstetrics patients. Materials and Methods: This cross-sectional study was conducted on 1296 Covid-19 asymptomatic women admitted to the Obstetrics and Gynaecology Department of Muhammad Teaching Hospital & Medical College, Peshawar and Fauji Foundation Hospital, Rawalpindi for the duration of six months from February 2021 to July 2021. Antigen-based test rapid diagnostic test (RDT) was used for screening out COVID-19 positive obstetrics patients or women through nasopharyngeal swabs. Women with negative rapid antigen test results were confirmed with RT-polymers chain reaction test of nucleic acid amplification tests (NAAT). Ethical approval and informed consent were taken from the hospital ethical committee and each individual respectively. All the known positive COVID-19 patients during admission were excluded. SPSS version 24 was used for data analysis. Results: The overall prevalence of rapid antigen-positive tested patients was 13.2% (171/1296). The prevalence of positive tested women through rapid antigen test, Nucleic Acid Amplification Test (NAAT), and RT-PCR were 27 (2.1%), 51 (3.9%), and 93 (7.2%) respectively. Of the total 1296 rapid antigen tests, 27 were positive, and the false-negative confirmed positive by NAAT was 144.Thus the sensitivity of the rapid antigen test was 15.8% and the negative predictive value was 93.7%. Of the total 298 Nucleic Acid Amplification Tested had sensitivity and negative predictive value of 89.6% and 99.06% respectively. RT-PCR was carried out on 972 patients, positive diagnosed cases were 36 while 15 were initially negative and were positive with the test was repeated. The sensitivity and negative predictive value was 71.45% and 95.8% respectively. Conclusion: Our study found that Ag-RDT plays a significant role in SARS-CoV-2 early detection in infected individuals, with high specificity and sensitivity to disease infectious stage, whether symptomatic or asymptomatic, and can be used as a decision supported tool. Early detection of COVID-19 status in women admitted for delivery could benefit neonatal protection care. Keywords: Covid-19; Rapid antigen test; RT-PCR test

Accuracy of real-time polymerase chain reaction to detect Schistosoma mansoni – infected individuals from an endemic area with low parasite loads

Parasitology ◽  
2020 ◽  
Vol 147 (10) ◽  
pp. 1140-1148
Author(s):  
Fernanda do Carmo Magalhães ◽  
Samira Diniz Resende ◽  
Carolina Senra ◽  
Carlos Graeff-Teixeira ◽  
Martin Johannes Enk ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Schistosoma Mansoni ◽  
Real Time ◽  
Diagnostic Methods ◽  
Control Measures ◽  
Rt Pcr ◽  
Chain Reaction ◽  
Cross Sectional ◽  
Intestinal Schistosomiasis ◽  
Polymerase Chain

AbstractDue to the efforts to control schistosomiasis transmission in tropical countries, a large proportion of individuals from endemic areas present low parasite loads, which hinders diagnosis of intestinal schistosomiasis by the Kato-Katz (KK) method. Therefore, the development of more sensitive diagnostic methods is essential for efficient control measures. The aim was to evaluate the accuracy of a real-time polymerase chain reaction (RT-PCR) to detect Schistosoma mansoni DNA in fecal samples of individuals with low parasite loads. A cross-sectional population-based study was conducted in a rural community (n = 257) in Brazil. POC-CCA® was performed in urine and feces were used for RT-PCR. In addition, fecal exams were completed by 18 KK slides, saline gradient and Helmintex techniques. The combined results of the three parasitological tests detected schistosome eggs in 118 participants (45.9%) and composed the consolidated reference standard (CRS). By RT-PCR, 117 out of 215 tested samples were positive, showing 91.4% sensitivity, 80.2% specificity and good concordance with the CRS (kappa = 0.71). RT-PCR identified 86.9% of the individuals eliminating less than 12 eggs/g of feces, demonstrating much better performance than POC-CCA® (50.8%). Our results showed that RT-PCR is a valuable alternative for the diagnosis of intestinal schistosomiasis in individuals with very low parasite loads.

scholarly journals Histomorphometric Study of Axillary Lymph Nodes in Different Age Groups

2019 ◽  
Vol 08 (04) ◽  
pp. 136-141
Author(s):  
Kafeel Hussain A. ◽  
Shaweez Fathima S. ◽  
V. Sathialakshmi
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Age Groups ◽  
Cross Sectional Study ◽  
Germinal Centers ◽  
Axillary Lymph Nodes ◽  
Strong Impact ◽  
Axillary Lymph ◽  
Cross Sectional ◽  
Age Related

Abstract Background Although some age-related changes in lymph node histoarchitecture have been described, they are seldom taken into account in traditional depictions of lymph nodes. Recently introduced clinical procedures, such as intranodal vaccinations have demonstrated the need for an accurate knowledge of the degenerative processes of lymph nodes. It is thus deemed necessary to obtain a detailed insight into anatomical changes within the lymph node throughout life as age-related degeneration can have a strong impact on the outcome of these new therapeutic strategies. Aim To study the size and shape of the lymph nodes and to establish the age-dependent histoarchitectural changes in the lymph nodes in different age groups. Materials and Methods A cross-sectional study was conducted in a total of 35 axillary lymph nodes. The adult axillary group of lymph nodes were from subjects aged between 18 and 70 years. The fetal lymph nodes were collected from 8 stillborn fetuses between 37 and 42 weeks. Thickness of the cortex and diameter of the germinal centers were measured using ocular and stage micrometer. Results None of the fetal lymphocytic follicles showed evidence of a prominent germinal center. The germinal centers of young adults were not only more numerous but also larger in size when compared with the old. An age-related involution of the paracortical region was witnessed in the axillary lymph nodes. No evidence of lipomatous atrophy was encountered in any of the fetal lymph nodes. Interesting evidence of it was encountered in younger age groups. However, this was the most prominent feature in the older groups.

scholarly journals A case series of Kimura’s disease: a diagnostic challenge

2018 ◽  
Vol 9 (7) ◽  
pp. 207-211 ◽  
Author(s):  
Vivek Kumar ◽  
Navneet Mittal ◽  
Yiwu Huang ◽  
Jasminka Balderracchi ◽  
Huo Xiang Zheng ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Hodgkin's Disease ◽  
Immunoglobulin E ◽  
Hodgkin’S Disease ◽  
Case Series ◽  
Kimura’S Disease ◽  
Pathological Features ◽  
Diagnostic Challenge ◽  
First Case

Kimura’s disease (KD) is a rare, benign disorder characterized by subcutaneous masses with regional lymph-node enlargement. It is considered to be due to chronic inflammation of unclear etiology. Most cases have been reported in young, 20–30-year-old men of Asian descent. The diagnosis of KD is based on pathological features and elevated immunoglobulin E levels. Characteristic pathological features include intact lymph-node architecture, florid germinal center hyperplasia, extensive eosinophilic infiltrates, and proliferation of postcapillary venules. However, these features can also be seen in Hodgkin’s disease or T-cell lymphoma, therefore, cases presenting as KD pose a diagnostic challenge. We report a case series of two cases with suspected KD at initial presentation, with one patient eventually diagnosed with Hodgkin’s disease after clinical progression. The first case was a 45-year-old Asian man who presented with bilateral thigh masses and significantly enlarged inguinal lymph nodes. The histopathology was characteristic and the patient had stable disease on treatment with cetirizine for 20 months. The second case was a 29-year-old African-American man who had progressive enlargement of the right neck lymph nodes extending into the mediastinum, with the original biopsy suggestive of KD. An initial search for Reed–Sternberg cells using immunohistochemical staining for CD15 and CD30 was negative. However, the patient developed neurological symptoms corresponding to tumor extension to the cervical and thoracic neural foramina. A repeat biopsy showed a lack of nodal structure and atypical large cells that were positive for CD30 staining. The patient was treated with chemotherapy with good response. We emphasize the importance of following the clinical course to render an accurate diagnosis. Both cases showed extensive eosinophilic infiltration and other KD-like pathological features. However, KD is rare; not missing a malignant diagnosis lies in high clinical suspicion and repeated exhaustive work up.

Sign in / Sign up

Export Citation Format

Share Document