Wide needle aspiration cytology in the diagnosis of lymphadenopathy in Zambia.

AIMS To study the value of wide needle (19 gauge) aspiration cytology in the diagnosis of lymph node disease in Zambia in the absence of a trained cytologist. METHODS Patients (n = 304) referred for surgical biopsy of an enlarged peripheral lymph node were studied prospectively. Surgical biopsy was routinely preceded by 19 gauge needle aspiration of the same node; aspirates were stained by haematoxylin and eosin and Ziehl Neelsen stains. RESULTS Of 232 aspirates, 182 contained sufficient material for cytological characterisation. Tuberculosis was diagnosed or suspected in 122 of 126 aspirates with histologically confirmed tuberculous lymphadenitis; reactive follicular hyperplasia in 31 of 38 patients with primary HIV lymphadenopathy; malignancy in all five patients with malignant nodes; and Kaposi's disease in four of nine patients with this. Tuberculous lymphadenitis was falsely suspected in four patients, as was reactive follicular hyperplasia in four, and Kaposi's disease in four. CONCLUSIONS Wide needle aspiration cytology is useful in the diagnosis of lymphadenopathy in Central Africa, with the exception of lymphadenopathic Kaposi's disease.