Source: International Congress 2015 – Case series and clinical conundrums in TB
Disease area: Thoracic oncology

Abstract

INTRODUCTIONLondon has a high incidence of TB, and the boroughs served by Barking, Havering, and Redbridge University Hospitals Trust (BHRUT) reflects a high risk population. A recent review of BHRUT TB lymphadenitis cases between 2009 and 2013 revealed more lymph node (LN) samples were sent for histology than microbiology, potentially impacting management of these patients.AIMTo identify whether age affected the diagnostic sampling of lymph nodes in TB lymphadenitis.METHODA retrospective analysis of the investigations performed against the age of the patient, using the London TB Register (LTBR) to identify cases of TB lymphadenitis in BHRUT between 2009 and 2013.RESULTS324 patients were identified. Of these, 231 (71.3%) had LN samples sent for histology, and 179 (55.2%) had LN samples sent for microbiology. This was analysed further for each age group (Table 1).

Table 1: Percentage of lymph node samples sent for histology and microbiology in each age group

AGE (years)	HISTOLOGY (%)	MICROBIOLOGY (%)
0-9 (n=8)	37.5	25.0
10-19 (n=10)	50.0	30.0
20-29 (n=86)	75.6	67.4
30-39 (n=107)	72.0	60.7
40-49 (n=47)	59.6	36.2
50-59 (n=30)	73.3	43.3
60-69 (n=16)	93.8	68.8
70-79 (n=15)	80.0	60.0
80-89 (n=5)	80.0	20.0

 

In addition, 50-80% of histological samples in each age group were consistent with a diagnosis of TB.CONCLUSIONIn the older population (>60 years), almost all LN samples were sent for histology, indicating that in this cohort of patients, the primary differential is of a histological nature, i.e. cancer, due to their age. This analysis suggests we should change our current multidisciplinary practice by sending all LN samples for microbiological investigation, as in high risk populations, TB should always be a differential for lymphadenitis.


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Kavita Dave (Milton Keynes, United Kingdom), Kavita Dave, Anita Saigal, Farhan Ullah, Ferduche Miah, Hardeep Kalsi, Robert Sands, Ajitha Jayaratnam. Age as a factor affecting the diagnostic accuracy of TB lymphadenitis. Eur Respir J 2015; 46: Suppl. 59, 2759

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