Evaluation of the Yield of Histopathology in the Diagnosis of Lymph Node Tuberculosis in Morocco, 2017: Cross-Sectional Study

Kenza Bennani; Asmae Khattabi; Mohammed Akrim; Mohamed Mahtar; Najib Benmansour; Leila Essakalli Hossyni; Mehdi Karkouri; Nadia Cherradi; My Driss El Messaoudi; Ouafae Lahlou; Imad Cherkaoui; Yousef Khader; Abderrahmane Maaroufi; Salah-Eddine Ottmani

doi:10.2196/14252

Evaluation of the Yield of Histopathology in the Diagnosis of Lymph Node Tuberculosis in Morocco, 2017: Cross-Sectional Study

JMIR Public Health Surveill. 2019 Oct 9;5(4):e14252. doi: 10.2196/14252.

Authors

Kenza Bennani^{1

2}, Asmae Khattabi^{2

3}, Mohammed Akrim^{2

3}, Mohamed Mahtar⁴, Najib Benmansour⁵, Leila Essakalli Hossyni⁶, Mehdi Karkouri⁷, Nadia Cherradi⁸, My Driss El Messaoudi⁹, Ouafae Lahlou¹⁰, Imad Cherkaoui¹, Yousef Khader¹¹, Abderrahmane Maaroufi¹, Salah-Eddine Ottmani¹²

Affiliations

¹ Direction of Epidemiology and Diseases Control, Ministry of Health, Rabat, Morocco.
² Morocco Field Epidemiology Training Program, Rabat, Morocco.
³ Ecole nationale de Santé publique, Rabat, Morocco.
⁴ Otorhinolaryngology Department, Hôpital du 20 Aôut, Casablanca, Morocco.
⁵ Otorhinolaryngology Department, Hôpital Hassan II, Fez, Morocco.
⁶ Otorhinolaryngology Department, Hôpital des Spécialités, Rabat, Morocco.
⁷ Histopathology Laboratory, Hôpital Ibn Rochd, Casablanca, Morocco.
⁸ Histopathology Laboratory, Hôpital des Spécilaités, Rabat, Morocco.
⁹ Tuberculosis Laboratory, Institut Pasteur Maroc, Casablanca, Morocco.
¹⁰ Tuberculosis National Reference Laboratory, Institut national d'Hygiène, Rabat, Morocco.
¹¹ Department of Public Health, Jordan University of Science and Technology, Amman, Jordan.
¹² Senior Expert on Tuberculosis, Silves, Portugal.

PMID: 31599732
PMCID: PMC6819008
DOI: 10.2196/14252

Abstract

Background: The frequency of occurrence of extrapulmonary tuberculosis (EPTB) has been increasing globally over the last two decades. In Morocco, EPTB cases account for 46% of the patients reported with a new episode of tuberculosis (TB). Lymph node TB (LNTB) is the most common form of EPTB. In line with the guidelines of the National TB Program, the diagnosis is mainly based on clinical evidence, including histopathology.

Objective: This study aimed to evaluate the yield of histopathology testing in the diagnosis of LNTB.

Methods: This cross-sectional, prospective study was conducted among patients with cervical lymph node who were enrolled in the study from November 2016 to May 2017 in three regions of Morocco. We compared the outcomes of histopathological testing with those of bacteriology. Sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) of histopathology testing were calculated. Culture and Xpert tests were used as the gold standard Laboratoty Testing.

Results: A total of 262 patients were enrolled in this study. The Se, Sp, PPV, and NPV of histopathology testing were 95.6% (129/135), 64.6% (82/127), 74.1% (129/174), and 93.2% (82/88), respectively, in the presence of granuloma with or without caseous necrosis and were 84.4% (114/135), 74.8% (95/127), 78.1% (114/146), and 81.9% (95/116), respectively, in the presence of granuloma with caseous necrosis. The granuloma with caseous necrosis was associated with increased PPV and Sp of histopathology testing (P<.05).

Conclusions: The presence of the granuloma with caseous necrosis in the histopathological examination had significantly improved the yield of histopathology testing for the diagnosis of LNTB. The findings recommend to maintain histopathology testing in establishing the LNTB diagnosis and to explore other techniques to improve it.

Keywords: Morocco; histopathology; lymph node tuberculosis; positive predictive value; yield.

©Kenza Bennani, Asmae Khattabi, Mohammed Akrim, Mohamed Mahtar, Najib Benmansour, Leila Essakalli Hossyni, Mehdi Karkouri, Nadia Cherradi, My Driss El Messaoudi, Ouafae Lahlou, Imad Cherkaoui, Yousef Khader, Abderrahmane Maaroufi, Salah-Eddine Ottmani. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 09.10.2019.