David Muyanja1, Robert Kalyesubula2, Elizabeth Namukwaya3, Emmanuel Othieno4, Harriet Mayanja-Kizza5. 1. School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda ; Mengo Hospital, Department of Medicine, Kampala, Uganda. 2. School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda ; Mulago National Referral Hospital, Kampala, Uganda ; Department of Physiology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda. 3. School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda ; Mulago National Referral Hospital, Kampala, Uganda ; Mulago Palliative Care Unit, Kampala, Uganda. 4. Mulago National Referral Hospital, Kampala, Uganda ; Department of Pathology, Makerere University College of Health Sciences, Kampala, Uganda. 5. School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Abstract
BACKGROUND: Opportunistic infections and malignancies cause lymphadenopathy in HIV-infected patients. The use and accuracy of fine needle aspiration cytology in diagnosing of cervical lymphadenopathy among HIV-infected patients is not well studied in Uganda. OBJECTIVE: The aim of this study was to determine the diagnostic accuracy of fine needle aspiration cytology in providing a diagnosis of cervical lymphadenopathy among HIV-infected patients in Uganda. METHODS: We consecutively recruited adult HIV-infected patients with cervical lymphadenopathy admitted to Mulago Hospital medical wards. Clinical examination, fine needle aspiration and lymph node biopsy were performed. We estimated the sensitivity, specificity; negative and positive predictive values using histology as the gold standard. RESULTS: We enrolled 108 patients with a mean age of 33 years (range, 18-60), 59% were men and mean CD4 was 83(range, 22-375) cells/mm(3). The major causes of cervical lymphadenopathy were: tuberculosis (69.4%), Kaposi's sarcoma-KS (10.2%) and reactive adenitis (7.4%). Overall fine needle aspiration cytology accurately predicted the histological findings in 65 out of 73 cases (89%) and missed 7 cases (9.5%). With a sensitivity of 93.1%, specificity of 100%, positive predictive value of 100% and negative predictive value of 78.7% for tuberculosis and 80%; 98.4%;88.9% and 98.9% for KS respectively. No fine needle aspiration complications were noted. CONCLUSIONS: Fine needle aspiration cytology is safe and accurate in the diagnosis of tuberculosis and KS cervical lymphadenopathy among HIV-positive patients.
BACKGROUND: Opportunistic infections and malignancies cause lymphadenopathy in HIV-infectedpatients. The use and accuracy of fine needle aspiration cytology in diagnosing of cervical lymphadenopathy among HIV-infectedpatients is not well studied in Uganda. OBJECTIVE: The aim of this study was to determine the diagnostic accuracy of fine needle aspiration cytology in providing a diagnosis of cervical lymphadenopathy among HIV-infectedpatients in Uganda. METHODS: We consecutively recruited adult HIV-infectedpatients with cervical lymphadenopathy admitted to Mulago Hospital medical wards. Clinical examination, fine needle aspiration and lymph node biopsy were performed. We estimated the sensitivity, specificity; negative and positive predictive values using histology as the gold standard. RESULTS: We enrolled 108 patients with a mean age of 33 years (range, 18-60), 59% were men and mean CD4 was 83(range, 22-375) cells/mm(3). The major causes of cervical lymphadenopathy were: tuberculosis (69.4%), Kaposi's sarcoma-KS (10.2%) and reactive adenitis (7.4%). Overall fine needle aspiration cytology accurately predicted the histological findings in 65 out of 73 cases (89%) and missed 7 cases (9.5%). With a sensitivity of 93.1%, specificity of 100%, positive predictive value of 100% and negative predictive value of 78.7% for tuberculosis and 80%; 98.4%;88.9% and 98.9% for KS respectively. No fine needle aspiration complications were noted. CONCLUSIONS: Fine needle aspiration cytology is safe and accurate in the diagnosis of tuberculosis and KS cervical lymphadenopathy among HIV-positivepatients.
Entities:
Keywords:
Fine needle aspiration cytology; HIV; cervical lymphadenopathy
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