Tuberculous cervical lymphadenopathy: should antituberculous therapy be preceded by histological proof?

In this retrospective study, 212 patients with cervical lymphadenopathy (CL ) were studied over a 4-year period (1987-1990). Ninety-six (45.3%) were fo und to be tuberculous, 64 (30.2%) had reactive hyperplasia, 31 (14.6%) had a malignant lymphoma, 12 (5.7%) showed metastatic carcinoma and nine (4.2%) were due to miscellaneous causes. The original provisional diagnosis was i ncorrect in 20 cases who were later found to have tuberculous lymphadenopat hy (TL) and in 12 patients with secondary malignancy who were originally di agnosed as tuberculous. The study shows that treatment should be preceded b y histological proof to avoid delay in treatment of serious malignant disor ders, to avoid unnecessary antituberculous treatment in patients with benig n reactive lymphadenopathy and to prevent delay of antituberculous treatmen t in tuberculous patients with atypical clinical presentations.