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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

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Abstract

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.

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Authors and Affiliations

  1. Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India

    Samir Mohindra, Hemanta Kumar Nayak, Alok Kumar, Vivek Anand Saraswat & Uday C. Ghoshal

  2. Department of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India

    Namita Mohindra

  3. Department of Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India

    Alok Kumar

  4. Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India

    Niraj Kumari

  5. Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India

    Richa Misra

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  1. Samir Mohindra
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  2. Hemanta Kumar Nayak
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  8. Uday C. Ghoshal
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Correspondence to Samir Mohindra.

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SM, HKN, NM, AK, VAS, NK, RM, and UCG declare that they have no conflict of interest.

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All procedures performed in work were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Mohindra, S., Nayak, H.K., Mohindra, N. et al. 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. Indian J Gastroenterol 40, 630–635 (2021). https://doi.org/10.1007/s12664-020-01136-6

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  • DOI: https://doi.org/10.1007/s12664-020-01136-6

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