Comparative study between recent diagnostic techniques in undetermined lymphadenopathies

ABSTRACT

One hundred patients presenting with prolonged unexplained lymphadenopathy undiagnosed either on clinical grounds or simple investigations during 3 years period were studied [1989-1991]. Besides thorough clinical examination, complete blood picture, the patients were subjected to sonographic examination of the lymph nodes, serological tests for detection of T. gondii, EBV, CMV, cytological and histopathological examination of lymph nodes. Histopathological and serological classification of the cases revealed that the majority [58 percent] of the cases proved to be infectious or benign conditions [toxoplasmosis 20 percent, infectious mononucleosis 9 percent, SLE 1 percent, tuberculosis 21 percent, sarcoidosis 4 percent, cat scratch disease 2 percent and angioimmunoblastic lymphadenopathy 1 percent] while lymphomas represented 42 percent of the cases. Histopathology of the lymph nodes was the corner stone of the diagnosis of the cases. Inspite of its overall 78 percent sensitivity rate, it gave conclusive diagnosis with 100 percent sensitivity rate in cases of granulomatous lymphadenitis, angioimmunoblastic lymphadenopathy and lymphomas. In cases of reactive lymphadenitis, serology was an easy, rapid, non-invasive and sensitive technique for diagnosis. Ultrasonography of the lymph nodes [81 percent sensitivity rate] and the abdomen proved to be an important tool in suggesting the diagnosis of lymphadenopathy whether benign [74 percent] or malignant [90 percent] and was useful in proper staging of the lymphomas. Fine needle aspiration cytology of the lymph nodes was found to be a simple, easy, rapid and sensitive [68 percent] procedure which offers a preliminary idea of facing a benign condition which could be verified serologically. The technique efficiently diagnosed tuberculous lymphadenitis [91 percent], Hodgkin [90 percent] and non-Hodgkin [87 percent] lymphomas