Validity of fine needle aspiration in evaluation of aetiology of cervical lymphadenopathy in adult HIV positive patients in mulago hospital.
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BACKGROUND: HIV is a pandemic most felt in sub Saharan Africa where it was the greatest impact. A number of opportunistic infections and malignancies are associated with this growing HIV pandemic and they have various manifestations including lymphadenopathy, cervical lymphadenopathy being the commonest manifestation in this category. The gold standard for evaluating lymphadenopathy is biopsy and histology, however, this is quite invasive, time consuming and expensive. The alternative less invasive, cheap, easy to perform and quick method is fine needle aspiration (FNA). Unfortunately this is under utilized in our setting, probably because its validity hasnot been documented in our setting. This study aimed at determining causes of cervical lymphadenopathy and the validity of fine needle aspiration in the evaluation of cervical of cervical lymphadenopathy among adult HIV positive patients in mulago hospital. STUDY SSETTING: Study particiapants were recruited from the general medical wards of mulago hospital, kampala, Uganda, using a consecutive non probability sampling. METHODS: A Cross sectional descriptive study with an analytical component in which HIV positive patients with cervical lymphadenopathy were recruited and those patients who were already diagnosed with TB by lymph node biopsy were excluded. After recruitment, history and examination findings were recorded in precorded forms. FNA and biopsy were then done at the same setting and the resulting specimens were processed by a senior experienced pathologist and laboratory technician. Blood was drawn for CD4 count. Informed conscent was obtained from all patients. RESULTS: One hundred and eight patients participated in the study with 59.3% males and an age range of (18-60 years). The FNA and histological diagnoses were compared. Overall FNA accurately predicated the histological findings in 65 out of the 73 cases. FNA had sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) in the diagnosis of tuberculosos of (93.1%, 100%, 100% and 78.7% respectively. For kaposi’s sarcoma, it was 80%, 98.4%, 88.9% and 96.8% respectively. For reactive adenitis it was 66.7%, 98.5%, 66.7% and 98.7% respectively. There were seven false negative FNAs, One FNA with dual pathology and no false positive FNA results. In 35 patients, only FNA was done. The ZN positive rate was 67.6% for the FNAs with tuberculosis. Ten (9.3%) FNA specimens were unsatisfactory. The cervical lymphadenopathy aetiologies found included tuberculosis (69.4%), kaposi’s sarcoma (10.2%), reactive adenitis (7.4%), Hodgkin’s lymphoma (3.7%), non Hodgkin’s lymphoma (0.9%), metastatic carcinoma (0.9%) and toxoplasmosis (0.9%) CONCLUSION: FNA had a high validity in the diagnosis of TB adenitis, less no in diagnosis of lymphadenopathic KS and it was least valid in diagnosis of reactive adenitis among HIV positive individuals with cervical adenopathy who participated in the study. Tuberculosis is currently the commonest cause of cervical lymphadenopathy among HIV patients who participated in the study.