A Comparative Clinical Study of Tuberculous and Non-Tuberculous Cervical Lymphadenopathy with Assessment of Clinical Features, Imaging Findings, Cytological Characteristics, and Treatment Outcomes

Abstract

Background: Cervical lymphadenopathy is a common clinical presentation with a wide range of infectious, inflammatory, granulomatous, and malignant causes. Tuberculous cervical lymphadenopathy remains an important cause of persistent cervical lymph-node enlargement in India and may clinically and radiologically mimic non-tuberculous conditions. Accurate differentiation is important for appropriate treatment and prevention of complications.

Aim: To compare tuberculous and non-tuberculous cervical lymphadenopathy with respect to clinical features, imaging findings, cytological characteristics, and treatment outcomes.

Materials and Methods: A prospective, hospital-based comparative study was conducted at Kodagu Institute of Medical Sciences, Madikeri, over a period of 6 months. Approximately 60 patients presenting with cervical lymphadenopathy and fulfilling the predefined inclusion and exclusion criteria were included. Patients were categorised into tuberculous and non-tuberculous groups based on clinical, radiological, cytological, microbiological, and/or histopathological findings. Clinical characteristics were recorded, and cervical lymph nodes were evaluated using ultrasonography and contrast-enhanced computed tomography where indicated. Fine-needle aspiration cytology (FNAC) was performed to assess granulomatous inflammation, epithelioid cell granulomas, caseous necrosis, Langhans-type giant cells, reactive lymphoid cells, and malignant cells. Treatment response was assessed during follow-up. Data were analysed using appropriate statistical tests, with a p-value <0.05 considered statistically significant.

Results: Of the 60 patients included in the study, 36 (60.0%) had tuberculous cervical lymphadenopathy, and 24 (40.0%) had non-tuberculous lymphadenopathy. Tuberculous lymphadenopathy was more frequently observed among younger adults. Painless cervical swelling was the predominant clinical presentation. Fever, weight loss, night sweats, lymph-node matting, and a history of tuberculosis exposure were more frequently observed in the tuberculous group. On imaging, central nodal necrosis, conglomeration, and peripheral/rim enhancement were more commonly associated with tuberculosis. FNAC demonstrated granulomatous inflammation, epithelioid cell granulomas, caseous necrosis, and Langhans-type giant cells predominantly in tuberculous lymphadenitis. Among non-tuberculous cases, reactive lymphadenitis was the most common diagnosis. The majority of patients with tuberculous cervical lymphadenopathy showed a favourable clinical response following anti-tubercular treatment.

Conclusion: Tuberculous cervical lymphadenopathy remains an important cause of cervical lymph-node enlargement. Clinical features such as painless swelling and nodal matting, radiological findings such as central necrosis and conglomeration, and cytological features such as granulomatous inflammation and caseous necrosis can aid in differentiating tuberculous from non-tuberculous lymphadenopathy. A combined clinical, radiological, cytological, and microbiological/histopathological approach is useful for accurate diagnosis and appropriate management.