Faculty of Public Health - Andalas University - OCS, 13th IEA SEA Meeting and ICPH - SDev

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Impact of fine needle aspiration cytology strategy implemented at the microscopy-center level for diagnosis and follow up of tubercular lymphadenitis
Quazi Toufique Ahmed

Last modified: 2018-08-07

Abstract


Background:Clinical-diagnosis of tubercular-lymphadenitis has poor specificity resulting in over-diagnosis,whereas Fine-Needle-Aspiration-Cytology(FNAC)strategy is highly sensitive(83-94%accuracy).However it is done mostly at tertiary-centers.This study was undertaken to determine feasibility and effectiveness of FNAC strategy implemented at designated microscopy center(DMC)level of RNTCP for tubercular-lymphadenitis detection.

Materials and methods:Randomized-Control-trial was done.FNAC Training was given at Medical-College for Medical-Officers(MO),DMC laboratory technicians            (intervention-group).All clinically-suspected tubercular-lymphadenitis cases in intervention units were subjected to FNAC by trained technicians under MO supervision.Ziehl-Neelson-staining was done on smeared slides and examined under microscope for presence of acid-fast-bacilli(AFB),granulomas/caseation necrosis indicating TB infection.

Results:FNAC was done on1298 presumptive Tubercular- Lymphadenitis cases during study period.After inclusion/exclusion criteria,294 cases were included in the intervention arm and 196 cases in the control.Comparisons of baseline variables indicated no significant statistical difference between control and intervention arms(p values< 0.05).Cervical lymph nodes were commonly affected(77%cases).No significant complication was detected for FNACs done at DMC level with high level of agreement in reports of FNAC slides between DMC and Medical College  Pathology Department(Kappa value0.097).

Conclusions and key recommendations: Implementation FNAC) strategy at tRNTCP-DMC level for detection of tubercular-lymphadenitis was found to be feasible and effective.Multi-centric studies with similar objectives should be conducted at DMC-level to validate the conclusions in diverse population groups.