Vol 43 # 3 September 2011 - Kma.org.kw

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KUWAIT MEDICAL JOURNAL
September 2011
Original Article
Correlation of Fine Needle Aspiration Cytological Features of
Extra-pulmonary Tuberculous Lesions with detection of Acid
Fast Bacilli – Mubarak Al-Kabeer Hospital, Kuwait Experience
Kusum Kapila 1,2 , Bahiyah E Haji 1 , Sara S George 1 , Mohammad Jaragh 1 ,Taiba A Alansary 1 , Eiman E Mokaddas 3 .
1
Department of Pathology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
2
Cytology Laboratory, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
3
Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
Kuwait Medical Journal 2011; 43 (3): 216-219
ABSTRACT
Objective: To correlate the spectrum of cytomorphological
changes in fine needle aspirates (FNA) of extra pulmonary
tuberculous lesions with the demonstration of acid fast bacilli
(AFB) by Ziehl-Neelsen (ZN) staining and culture of the
mycobacterial organism
Design: Prospective, from January 2008 to August 2009
Setting: Mubarak Al-Kabeer Hospital, Kuwait
Subjects: Three hundred and eighty-one patients with
suspected tuberculosis
Intervention: FNA was done on lymph nodes (313 cases,
82%), soft tissue (37 cases, 10%), breast (24 cases, 6%), thyroid
(3 cases, 1%) and epididymis (4 cases, 1%). Papanicolaou and
/ or May-Grunwald-Giemsa (MGG) stained smears were
classified into: Group A: granulomas with necrosis (n = 202,
53%), Group B: granulomas alone (n = 59, 15.5%), Group C:
acellular necrosis alone (n = 53, 13.9%) and Group D: acute
inflammatory exudate (n = 67, 17.6%).
Main Outcome Measure(s): The cytomorphological features
of extra-pulmonary tuberculosis in FNA were correlated
with AFB demonstration by ZN staining and mycobacterial
culture.
Results: The AFB positivity by ZN stain was 46.6, 7.9, 58.1
and 22% in groups A, B, C and D respectively. Culture was
positive in 53.1, 6.7, 56 and 15.4% in groups A, B, C and D
respectively. In 32 out of 109 cases both ZN staining and
culture were positive. In 77 cases negative for AFB the culture
was positive in 31.2% and negative in 68.8%.
Conclusion: Evaluation of all FNA from suspected cases of
tuberculosis should include staining for AFB and culture for
mycobacteria.
KEY WORDS: acid fast bacilli, cytomorphological spectrum, extra-pulmonary tuberculosis
INTRODUCTION
Tuberculosis (TB) is on the rise globally, with
an estimated one-third of the world’s population
being infected with Mycobacterium tuberculosis and
approximately 3 - 4 million new cases every year [1] .
Pulmonary TB is most common but isolated extrapulmonary
organ involvement is well-known, the
common sites being lymph nodes, kidney, long
bones, genital tract, brain and meninges [2] . Studies
from developed countries have reported that
extra pulmonary TB is on the rise due to human
immunodeficiency virus (HIV) epidemic. High burden
countries with low prevalence of HIV have also reported
an increase [3,4] . Demonstration of acid fast bacilli (AFB)
in smears and culture of sputum is widely employed
for diagnosis of pulmonary TB. However, biopsy with
histopathological examination and demonstration of
AFB has been the gold standard for diagnosis of extrapulmonary
lesions. With the advent of fine needle
aspiration cytology (FNAC) the scenario has changed.
FNAC, a simple, cost effective, non-invasive technique
is readily performed in the out-patient setting and
has proved to be useful in the diagnosis of TB from
practically any site in the body. Palpable masses
anywhere in the body are easily amenable to FNAC
and the technique has assumed an important role in
the evaluation of peripheral adenopathy as a possible
non-invasive alternative to excisional biopsy [5-7] .
Very few reports document the use of FNAC in the
diagnosis of extra-pulmonary TB in palpable masses
in the Middle East [3,6,7] . The purpose of this study was
to identify the spectrum of cytomorphological changes
seen in aspirates from palpable masses from patients
suspected to have extra-pulmonary TB. We also tried
Address correspondence to:
Kusum Kapila, MD, FAMS, FIAC, FRCPath, Professor & Head, Cytology Unit, Department of Pathology, Faculty of Medicine, Kuwait University
P O Box 24923, Safat 13110, Kuwait. Tel: 2531 9476 or 2498 6247, Fax: +965-2533 8905, E-mail: kkapila@hsc.edu.kw