Exploring the Links Between Quality Assurance and Laboratory Resources (original) (raw)
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Quality Control for Cytology Laboratory in the USA
Thyroid FNA Cytology, 2019
Quality control in the cytology laboratory comprises many aspects of laboratory practice that are common to all medical laboratories but some that are unique. In the application to cytology, there are further, special considerations. This chapter describes quality control and quality assurance activities specific to cytology which requires continuous monitoring and are mandatory by the Clinical Laboratory Improvement Amendments of 1988 (CLIA '88) regulations. This chapter also describes how to document review activities and monitor their effectiveness in improving performance in gynecological, non-gynecological, and fine needle aspiration cytology techniques.
International Journal of Medical Research and Review, 2016
Introduction: In a developing country like India, tuberculous lymphadenitis is one of the most common presentations at OPDs. However, anti-tubercular treatment cannot be administered only on clinical suspicion. Cytomorphology with acid fast staining proves to be a valuable tool in diagnosing these cases along with culture. The study was undertaken to study the utility, limitations of fine needle aspiration cytology and various cytomorphological presentations in reference to Ziehl-Neelsen staining in tuberculous lymphadenitis and correlate the culture findings. Methods: The study was conducted for duration of two years with total of 170 cases at a tertiary care centre. The patients with clinically suspected lymphadenopathy were selected. Results: The incidence of tuberculous lymphadenitis was 68.8%. Overall AFB positivity was 64.1%. Epithelioid cell granulomas with lymphocytes were the most common cytological picture and cases showing necrosis had highest AFB positivity. Maximum patients presented in second to fourth decade of life. Cervical region was the most common site of involvement with solitary lymphadenopathy as the most common presentation in contrast to matted lymph nodes as reported by others. Conclusion: Yet again Fine needle aspiration cytology is a safe, cheap and reliable procedure requiring minimal instrumentation and is highly sensitive to diagnose tuberculous lymphadenitis. The diagnostic index can be further increased by complementing cytomorphology with acid fast staining and culture techniques. However FNAC complimented with techniques like ELISA and PCR would give better dimensions to the current scenario of diagnosis and treatment modalities.
2015
Background: Tuberculous Lymphadenitis is the commonest form of extra pulmonary tuberculosis and tissue diagnosis is the main stay in the diagnosis of extra-pulmonary tuberculosis. This study was conducted to compare cytology, ZN staining and culture findings of clinically suspected tuberculosis lymphadenitis cases. Methods: In the Present Study clinically suspected cases of Lymphadenopathy were undergone Fine Needle Aspiration. The aspirate were examined cytologically followed by ZN staining and BACTEC culture. Results: The cytology suggestive of tuberculous lymphadenitis was found in 46(76.6%) cases out of total 61 cases. Ziehl Neelsen stain demonstrated acid fast bacilli (AFB) in 14 (22.9%) cases and BACTEC isolated mycobacteria in 36 (59%) cases. Out of 61 cases as many as 15(24.5%) cases yielded pus and in 13 of those cases cytology of tuberculous lymphadenitis was found. Cases from blood mixed aspirate demonstrated AFB positivity in 2 (5.88%) and mycobacteria were isolated in 1...
Journal of Evidence Based Medicine and Healthcare
BACKGROUND Tuberculous lymphadenitis is the commonest form of extrapulmonary tuberculosis and tissue diagnosis is the mainstay in the diagnosis of extrapulmonary tuberculosis. This study was conducted to compare cytology, ZN staining, fine-needle aspiration technique and culture findings of clinically suspected tuberculous lymphadenitis cases. MATERIALS AND METHODS This is a descriptive study. Total 300 patients of lymphadenopathy referred to the Department of Microbiology, Anugrah Narayan Magadh Medical College, Gaya, Bihar and Associated Hospital of Bihar between May 2014 and May 2017, were included. Using solid culture (BACTEC) as the gold standard, we assessed the sensitivity, specificity, positive predictive value (PPV) and negative predictive value of the FNAC for detecting MTB and ZN staining for acid-fast bacilli (AFB) respectively. RESULTS A total of 300 fine-needle aspirated specimens from lymph nodes were included in the study. Out of 300 cases, 140 aspirates were reported as cytomorphology suggestive of tuberculous lymphadenitis. The age ranged from 1 to 70 years, with the mean age of 35.5 years. Female preponderance was noted accounting for 57.14% (80/140) of cases. Maximum number of patients were from age group of 10-29 years comprising 42.15% of the group (59/140). Out of 300 cases, 68(48.57%) had lymphadenitis other than tuberculosis, and 16 (11.43%) had malignant lymphadenopathy, including 04 (02.84%) cases of primary malignancy (i.e., lymphoma) and 13 (09.28%) of secondary metastasis to lymph nodes. Though cytology suggestive of tuberculous lymphadenitis was found in 140 (46.67%) cases out of total 300 cases,Ziehl-Neelsen stain demonstrated acid-fast bacilli (AFB) in 60 (20.00%) cases and BACTEC isolated mycobacteria in 80 (26.67%) cases. When culture (BACTEC) is taken as the gold standard, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the FNAC in the diagnosis of TB lymphadenitis results was 96.55%, 96.38%, 95.89% and 96.96% as per this study and if ZN stain is taken as the standard for diagnosis, the sensitivity, specificity, PPV and NPV were 95.23%, 99.17%, 96.77% and 98.76% respectively. CONCLUSION FNAC is an assay which has high sensitivities when optimally selected is efficient and one of the most accurate frontline method for the diagnosis of Tuberculous Lymphadenitis. It is effectively supplemented by Ziehl-Neelsen Staining which is the most simple, quicker, reliable and relatively cheap diagnostic tool. Culture methods (BACTEC) can be reserved to obtain more accurate diagnosis.
Diagnostic Accuracy of Fine Needle Aspiration Cytology in Diagnosis of Tuberculous Lymphadenitis
Journal of Enam Medical College, 2019
Background: Tuberculosis is still a global health problem. Most common presentation of extrapulmonary tuberculosis is tuberculous lymphadenitis. In our setting, keeping huge burden of tuberculosis in mind, clinicians have to depend on pathological diagnosis of enlarged lymph nodes, i.e., cytomorphology with acid-fast staining in diagnosing these cases so that diagnosis and management of such cases can be initiated quickly. Fine needle aspiration cytology (FNAC) of lymph nodes has been a simple, rapid and cost-effective procedure for diagnosis of various causes of lymphadenopathies. Objective: To determine the diagnostic accuracy of fine needle aspiration cytology in providing a diagnosis of tuberculous lymphadenitis patients in Bangladesh. Materials and Methods: This cross-sectional study was done on 317 subjects in Bangabandhu Sheikh Mujib Medical University (BSMMU) in collaboration with icddr,b. After clinical examination, fine needle aspiration (FNA) was done. The FNA materials were processed for Papanicoulaou staining (PAP stain), Ziehl-Neelsen staining and culture for the diagnosis of tuberculosis. Sensitivity, specificity, positive and negative predictive values of FNAC were determined where culture was taken as the gold standard. Results: Initially 351 clinically suspected tuberculous lymphadenitis patients were enrolled, but 34 cases were excluded due to diagnosis of malignancy. Among them 123 were male and 194 were female. Mean age was 27.91±13.16 years. Among the subjects 95.9% presented with cervical lymphadenopathy, others presented with lymphadenopathy of axillary or other groups of lymph nodes. The results of cytomorphological diagnosis of TB were in 58.36% cases, and culture was positive in 23.3% cases. Sensitivity, specificity, positive predictive value and negative predictive value of cytomorphological diagnosis were 79.7%, 48.1%, 31.9% and 88.6% respectively. Conclusions: FNAC is an effective diagnostic method for tuberculous lymphadenitis. It can diagnose granulomatous inflammation as well as reactive and other disease conditions including malignancies, thereby providing more information about the patient's disease status.
IP international journal of medical microbiology and tropical diseases, 2022
Objective: To describe laboratory personnel's attitude and practices toward phenol exposure during Ziehl Neelsen (ZN) acid fast staining method and to evaluate the feasibility of an alternate modified Kinyoun cold (MKC) stain. Method: A total of 187 sputum samples were collected from suspected tuberculosis cases and stained by the MKC method and ZN stain and were read by an experienced microscopist and a researcher. A crosssectional questionnaire survey of 35 laboratory personnel was also conducted. Results: Modified Kinyoun cold stain gave sensitivity, specificity, positive and negative predictive values of 100%, 99.4%, 94.1% and 100%, respectively. Both stains corresponded with an agreement rate of 99.5%. Almost 94.7% of respondents reported that they worked in a closed area when staining and 57.1% did the staining method without ventilation. Material safety data sheet (MSDS) of phenol was not known to 77.1% of laboratory personnel. All of the participants (100%) in this study welcomed a similar, non heating method for acid-fast bacillus (AFB). There was significant association between those not comfortable with phenol exposure (77.1%) and complaints of irritation (48.6%) and headache (2.9%) [χ 2 = 10.98, r = 0.55, p = 0.001]. Conclusions: The MKC is suitable for use as a substitute for the ZN method for the demonstration of AFB in the primary diagnosis and treatment assessment of pulmonary tuberculosis. Focus should be given on educating laboratory staff on the hazards, risks and precautions associated with the phenol/ZN method.
Indian Journal of Pathology and Oncology, 2023
Background: Tuberculous lymphadenitis is the most common etiology of cervical lymphadenopathy in endemic countries. Fine needle aspiration of palpable lymph nodes is done for rapid diagnosis of tuberculous lymphadenitis This study presents a comparative evaluation of fine needle aspiration cytology (FNAC) with acid fast bacilli screening using Ziehl Neelsen stain, Fluorescent stain with Cartridge based nucleic acid amplification test (CBNAAT) for the rapid diagnosis of Tubercular Lymphadenitis. Materials and Methods: An observational cross sectional study was done over a period of 15 months from January 2020 to March 2021. All newly diagnosed cases of Tubercular lymphadenitis irrespective of age and sex were included. Fine needle aspiration was performed from the palpable lymph node. Smears were prepared using Giemsa, Papanicolaou, Ziehl Neelsen and Auramine O stain.Rest of the sample was used for Mycobacterial growth indicator test (MGIT) and CBNAAT. Statistical Analysis was performed using McNemar test. For gold standard, MGIT as well as a composite reference standard on parameters that included MGIT, radiological findings of tuberculosis, Positive Mantoux test and Positive response to ATT seen in the form of complete resolution of clinical and radiological findings. Results: The diagnostic value of CBNAAT differed with respect to the chosen gold standard. With MGIT as gold standard, CBNAAT had the highest sensitivity, specificity, positive predictive value and negative predictive value. The diagnostic accuracy of CBNAAT was also the highest. Using CRS (Composite Reference standard) as gold standard, CBNAAT showed the highest specificity and positive predictive value. Conclusion: With CBNAAT showing statistically significant data of a higher diagnostic value in our study as well as showing rapid result, being automated and not subjected to observer interpretation, we conclude that CBNAAT is more efficient in the diagnosis of Tubercular lymphadenitis as compared to AFB screening methods. The only limitation of CBNAAT in our study was its ability to show positive results for three atypical mycobacteria due to possible cross contamination. Keywords: Rapid diagnosis, CBNAA, Auramine O, Ziehl Nielsen.
2015
Background: Lymphadenopathy is one of the most common clinical presentation among patients. In developing countries such as India, tuberculous (TB) lymphadenitis is one of the common causes of lymphadenopathy. Cytomorphology with acid-fast staining is a valuable diagnostic tool in cases of tuberculosis. Objective: To describe pattern of TB lymphadenitis presentation, and to compare results of fine needle aspiration cytology (FNAC) and Ziehl-Neelsen (ZN) stain in the diagnosis of TB lymphadenitis.
Pathology Research International, 2013
Objective. To study the correlation of cytomorphological features in fine needle aspiration smears from patients suspected of having tuberculous lymphadenitis with Ziehl-Neelsen staining (ZN), auramine-rhodamine staining (ARS), and autofluorescence (AF). Methods. A total of 145 lymph nodes were aspirated, 3 air-dried smears were stained with Giemsa, Ziehl-Neelsen, and auraminerhodamine stains, and 1 smear was wet fixed for Papanicolaou staining. Needle washes were incubated in Lowenstein-Jensen medium for culture. Papanicolaou and auramine-rhodamine stained smears were examined under fluorescent microscope using a blue excitation filter (450-480 nm). Results. Ninety aspirates were reported on cytomorphology as suggestive of tuberculous lymphadenitis. Smear positivity for Mycobacteria by Ziehl-Neelsen method was 26.67% (24/90), while positivity increased to 34.44% (31/90) by auramine-rhodamine and 42.22% (38/90) on autofluorescence. Culture was positive in 27.78% (25/90) aspirates. Using culture as the reference method, the statistical values of ZN, ARS, and AF were as follows: sensitivity 80.0%, 88.0%, 96.0%; specificity 93.85%, 86.15%, 78.46%; positive predictive values 83.33%, 70.97%, 63.16%; and negative predictive values 92.42%, 94.92%, 98.08%, respectively. Conclusion. There is a definite advantage of autofluorescence over Ziehl-Neelsen and auraminerhodamine which is to detect Mycobacteria, being more sensitive as well as an inexpensive technique. Autofluorescence can be a useful addition to routine cytology for early diagnosis and effective treatment.