Diagnostic yield of endoscopic ultrasound–guided fine-needle aspiration of tubercular lymphadenitis using combination of cytology and Gene Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) genes

Diagnostic yield of an automated molecular test, Gene Xpert Mycobacterium tuberculosis /rifampicin (MTB/RIF), was evaluated in this study to simultaneously detect the MTB gene and resistance to rifampicin (RIF) on cytology samples acquired via endoscopic ultrasound (EUS)–guided fine-needle aspiratio...

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Published in:Indian journal of gastroenterology 2021-12, Vol.40 (6), p.630-635
Main Authors: Mohindra, Samir, Nayak, Hemanta Kumar, Mohindra, Namita, Kumar, Alok, Saraswat, Vivek Anand, Kumari, Niraj, Misra, Richa, Ghoshal, Uday C.
Format: Article
Language:English
Subjects:
Adult
Drug Resistance, Bacterial - genetics
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Female
Gastroenterology
Hepatology
Humans
Lymphadenitis
Male
Medicine
Medicine & Public Health
Mycobacterium tuberculosis - genetics
Retrospective Studies
Rifampin
Sensitivity and Specificity
Short Report
Tuberculosis, Lymph Node - diagnosis
Tuberculosis, Lymph Node - microbiology
Tuberculosis, Lymph Node - pathology
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Summary:Diagnostic yield of an automated molecular test, Gene Xpert Mycobacterium tuberculosis /rifampicin (MTB/RIF), was evaluated in this study to simultaneously detect the MTB gene and resistance to rifampicin (RIF) on cytology samples acquired via endoscopic ultrasound (EUS)–guided fine-needle aspiration (FNAC) in suspected tubercular lymphadenitis. Microscopy, cytology, Gene Xpert MTB/RIF assay data on Acid-fast bacillus (AFB), and traditional culture of lymph nodes were retrospectively analyzed. Thirty-one patients (median age 33.5 years, inter-quartile range [IQR] 21–66, 18, 58% female) presented with fever (28, 90%), dysphagia (2, 7%), and recurrent subacute intestinal obstruction (1, 3%). Gene Xpert showed higher sensitivity (30, 97%) compared to the other tests: cytology (23, 77%; odds ratio [OR] 8.8, 95% confidence interval [CI] 1.0–76.9; p  = 0.05), AFB smears (12, 39%; OR 50, 95% CI 5.9–420.4; p  = 0.00001), and conventional culture (4, 13%; OR 188.5, 95% CI 19.7–1796.3; p  = 0.0000). We conclude that Gene Xpert MTB/RIF test on EUS-guided FNAC samples is very useful to diagnose tubercular lymphadenitis.
ISSN:0254-8860
0975-0711
DOI:10.1007/s12664-020-01136-6