Accuracy of Fine Needle Biopsy (FNAB) in Lymph Nodes Tuberculosis

Aditya Sita Sari, Nila Kurniasari, Anny Setijo Rahaju, Etty Hary Kusumastuti, Alphania Rahniayu

Abstract


Introduction: Tuberculosis (TB) is an infection caused by Mycobacterium Tuberculosis (Mtb) that can attack various organs such as peripheral lymph nodes. Fine needle aspiration biopsy (FNAB) is often used as one of the modalities of diagnosis of lymph node tuberculosis to determine the management of patients. Objective: The objective of this study is to evaluate the accuracy, efficiency, and effectiveness of FNAB in diagnosing lymph node tuberculosis. The findings will assess whether FNAB can be adopted as a standard diagnostic and management tool for patients with this condition. Methods: This is an observational analytic cross-sectional study in the population of patients with suspicion of lymph node tuberculosis at the Anatomical Pathology Unit of Dr. Soetomo General Academic Hospital Surabaya in one year period. FNAB examination was performed with Modified Grunwald Giemsa (MGG) and Ziehl Nielsen (ZN) staining to detect AFB (Acid Fast Bacilli) organisms, as well as PCR (Polymerase Chain Reaction) of peripheral blood. The results were analysed using Chi square statistic test. Results: The sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of FNAB examinations were 100%, 33%, 59% and 100%, respectively, meanwhile the sensitivity and specificity of PCR peripheral blood examination were 8% and 70% compared to the ZN examination of the FNA aspiration material. Conclusion: FNAB had a higher sensitivity than PCR of peripheral blood to detect Mycobacterium Tuberculosis infection; on the other hand PCR of peripheral blood had a higher specificity than FNAB to detect Mycobacterium Tuberculosis infection.


Keywords


FNAB, Lymph node, Tuberculosis, Infection

Full Text:

PDF

References


. Kemenkes RI. Pengendalian Penyakit [Internet]. Data dan Informasi Kesehatan Profil Kesehatan Indonesia. Jakarta; 2023 [cited 2025 Jun 28]. Available from: https://kemkes.go.id/app_asset/file_content_download/172231123666a86244b83fd8.51637104.pdf

. Sheereen,S, Manva, MZ, Sheereen, S, Patil, N, Exploring the Complexities: Understanding the Clinicopathological Spectrum of Tuberculosis in the Head-and-neck Region. International Journal of Mycobacteriology 13(2):p 147-151, Apr–Jun 2024. | DOI: 10.4103/ijmy.ijmy_89_24

. Kumbi H, Ali MM, Abate A. Performance of fine needle aspiration cytology and Ziehl-Neelsen staining technique in the diagnosis of tuberculosis lymphadenitis. BMC Infect Dis. 2024;24(1):633. Published 2024 Jun 25. doi:10.1186/s12879-024-09554-z

. Suryadi DS, Delyuzar, Soekimin. Diagnostic accuracy of tuberculous lymphadenitis fine needle aspiration biopsy confirmed by PCR as gold standard. IOP Conf Ser: Earth Environ Sci. 2018;125:012048. doi:10.1088/1755-1315/125/1/012048.

. Sigmon DF, Fatima S. Fine Needle Aspiration. [Updated 2022 May 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557486/

. Mulugeta F, Tiruneh M, Abebe B, et al. Evaluation of modified bleach technique for the detection of acid fast bacilli in lymph node aspirate at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. J Clin Tuberc Other Mycobact Dis. 2022;28:100328. Published 2022 Aug 5. doi:10.1016/j.jctube.2022.100328

. Cronan MR. In the thick of it: formation of the tuberculous granuloma and its effects on host and therapeutic responses. Front Immunol. 2022;13:820134. doi:10.3389/fimmu.2022.820134.

. Jusuf Fantoni, O. J., Inda Astri Aryani, Yuli Kurniawati, & Raden Pamudji. (2021). Histopathological Features of Cutaneous Tuberculoid Granuloma Disorders. Bioscientia Medicina : Journal of Biomedicine and Translational Research, 5(9), 825-836. https://doi.org/10.32539/bsm.v5i9.347

. Kumbi H, Ali MM, Abate A. Performance of fine needle aspiration cytology and Ziehl-Neelsen staining technique in the diagnosis of tuberculosis lymphadenitis. BMC Infect Dis. 2024;24(1). available online :https://www.springermedizin.de/performance-of-fine-needle-aspiration-cytology-and-ziehl-neelsen/27254604

. Osei-Wusu S, Asare P, Danso EK, et al. Addressing key risk factors hindering tuberculosis control activities in West Africa - progress in meeting the UN sustainable development goals. IJID Reg. 2025;14(Suppl 2):100594. Published 2025 Mar 19. doi:10.1016/j.ijregi.2025.100594

. Fahdhienie F, Mudatsir M, Abidin TF, Nurjannah N. Risk factors of pulmonary tuberculosis in Indonesia: A case-control study in a high disease prevalence region. Narra J. 2024;4(2):e943. doi:10.52225/narra.v4i2.943

. Arliny Y, Yanifitri DB, Utami WA, Geraldine S. Case Report: Tuberculosis lymphadenitis with systemic lupus erythematosus in a young woman: a case report. F1000Res. 2023;12:763. Published 2023 Oct 16. doi:10.12688/f1000research.135076.2

. Gopalaswamy R, Dusthackeer VNA, Kannayan S, Subbian S. Extrapulmonary Tuberculosis—An Update on the Diagnosis, Treatment and Drug Resistance. Journal of Respiration. 2021; 1(2):141-164. https://doi.org/10.3390/jor1020015

. Zaporojan N, Negrean RA, Hodișan R, Zaporojan C, Csep A, Zaha DC. Evolution of Laboratory Diagnosis of Tuberculosis. Clinics and Practice. 2024; 14(2):388-416. https://doi.org/10.3390/clinpract14020030

. Algarni A, Alansari N, Alqurashi M, Alsaeed M. Clinical characteristics and outcome of Tuberculosis lymphadenitis in a tertiary center from Saudi Arabia. J Clin Tuberc Other Mycobact Dis. 2023;33:100384. Published 2023 Jun 13. doi:10.1016/j.jctube.2023.100384

. Anggraini, D. and Oktora, M.Z. 2021. Hematology Profile of Tuberculosis Lymphadenitis Patients at Siti Rahmah Hospital, Padang, Indonesia. INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY. 27, 3 (Sep. 2021), 271–275. DOI:https://doi.org/10.24293/ijcpml.v27i3.1719.

. Febriza A, Anugrah R, Tajuddin A. Association between smoking behavior and pulmonary tuberculosis incidence. Mega Buana J Med Sci. 2025;1(1).available online : https://e-jurnal.umegabuana.ac.id/index.php/MBJMS/article/view/87

. Yenilmez E, Özakınsel D, Köse A, et al. Diagnostic approach of tuberculous lymphadenitis in a multicenter study. J Infect Dev Ctries. 2024;18(5):742-750. Published 2024 May 30. doi:10.3855/jidc.19502

. Lemus LF, Revelo E. Cervical Tuberculous Lymphadenitis. Cureus. 2022;14(11):e31282. Published 2022 Nov 9. doi:10.7759/cureus.31282

. Pradhan, S., Trilochan, B. P., Roy, D., Dhone, P. G., Routray, P. N., & Rai, N. (2022). Cervical tuberculous lymphadenitis: Clinicopathological profile with correlation to ultrasonography. International Journal of Health Sciences, 6(S2), 12918²12928. https://doi.org/10.53730/ijhs.v6nS2.8424

. Shiloh MU. Mechanisms of mycobacterial transmission: how does Mycobacterium tuberculosis enter and escape from the human host. Future Microbiol. 2016;11(12):1503-1506. doi:10.2217/fmb-2016-0185

. Tobin EH, Warda K, Gropper C, et al. Cutaneous Tuberculosis. [Updated 2025 May 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482220/

. Kurniawan D, Satria G, Wijayanti DR, Legiran. Sensitivity and specificity of pleural fluid cytology to histopathology examination in lung tumor patients at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia. Sriwijaya J Surg. 2024;7(1):[page range]. doi:10.37275/sjs.v7i1.97

. Adigun R, Basit H, Zubair M, et al. Cell Liquefactive Necrosis. [Updated 2025 Jan 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430935/

. Helle OMB, Kanthali M, Akhtar N, Purohit MR, Mustafa T. Significance of non-granulomatous cytomorphology on fine needle aspirate in lymphadenitis cases classified as tuberculous by using a composite reference standard. Diagnostic Cytopathology. 2023; 51(9): 575-583. doi:10.1002/dc.25167

. Purbaningsih W, Rachmawati M, Triyani Y, Rahmi FS. Histopathological review of granuloma in diagnosis of tuberculosis lymphadenitis (TBL). Glob Med Health Commun. 2023;11(3):[page range]. doi:10.29313/gmhc.v11i3.12742

. Nur TE, Shirin A, Saha MM. Diagnostic accuracy of fine needle aspiration cytology in diagnosis of tuberculous lymphadenitis. J Enam Med Coll. 2019;9(1) doi:10.3329/jemc.v9i1.39901

. Mustafa O, Mohamed E, Omer A, Mohamed A, Abdemagid S, Ali A, et al. Evaluation of Fine-needle Aspiration Cytology (FNAC) Sensitivity Compared to PCR for Diagnosing Tuberculosis Lymphadenitis. SJMS [Internet]. 2022 Sep. 30 [cited 2025 Jun. 26];17(3):330-4. Available from: https://kneopen.com/sjms/article/view/12103

. Rahman A, Hossain MK, Ali E, Rus’d AA. Peripheral Blood Sample May Not the Specimen of Choice for the Detection of Mycobacterium Tuberculosis ( Mtb ) By Genexpert Pcr Assay. Jagannath Univ J Life Earth Sci. 2021;6(2):155–60.

. Rees CE, Swift BM, Haldar P. State-of-the-art detection of Mycobacterium tuberculosis in blood during tuberculosis infection using phage technology. Int J Infect Dis. 2024;141S:106991. doi:10.1016/j.ijid.2024.106991




DOI: https://doi.org/10.33854/heme.v8i1.1875

DOI (PDF): https://doi.org/10.33854/heme.v8i1.1875.g646

Refbacks

  • There are currently no refbacks.


Creative Commons License   Health and Medical Journal This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.