Ultrasound-guided needle aspiration biopsy (US-NAB) of neck nodes in patients with suspected tuberculosis: a diagnostic challenge for respiratory physicians

<bold>Background:</bold> One of the most frequent form of extrapulmonary tuberculosis (TB) is cervical lymphadenopathy. Very few studies in the literature documented the use of ultrasound-guided needle aspiration biopsy (US-NAB) of neck nodes to diagnose tuberculosis, moreover this procedure was traditionally done by radiologists. <bold>Aims:</bold> To evaluate the diagnostic power and safety of US-NAB of neck nodes in a referral centre for tubercolosis in the hands of pneumologists and infectivologists. <bold>Methods:</bold> From March 2023 to January 2024 we enrolled 16 patients with enlarged lymph nodes in the neck suspicious for TB (country of origin, positive or indeterminate quantiferon, clinical and radiological presentation). All the procedures were performed by respiratory physicians with 18G needles using “free hand” technique. <bold>Results:</bold> Mean age was 38 years, male predominance (60%), one HIV+ (6%). Lymph node TB was diagnosed in 11 patients: 8 with consistent histology and/or positive PCR or culture for M. tuberculosis, 3 with sample of necrotic material in patients with pulmonary TB. Other diagnosis were: non-TB mycobacteriosis (1 patient), sarcoidosis (1 patient), thymic carcinoma (1 patient), lung cancer (1 patient, sufficient material for molecular testing), bacterial lymphadenitis (1 patient). US-NAB of neck nodes allowed to achieve a definitive diagnosis in 100% of cases even in the most complicated ones. No complications were observed. <bold>Conclusions:</bold> In our experience US-NAB of neck nodes allows a high diagnostic power for TB and for its differential diagnoses, moreover it is a safe procedure in hands of trained physicians.