TY  - BOOK
AU  - Joshi, Bishal Raj Dr.
TI  - Diagnostic accuracy of fibrosis-4 index in assessment of hepatic fibrosis in metabolic dysfunction associated steatotic liver disease
PY  - 2025///
CY  - Kathmandu, Nepal
PB  - Kathmandu University & Nepal Health Research Council (NHRC)
KW  - Extrapulmonary tuberculosis
KW  - Lymphadenitis
KW  - Sensitivity and specificity
KW  - Tuberculosis
KW  - Nepal
N1  - In partial fulfilment of the requirements for the degree of Master in Medical Research
N2  - Background: Tuberculosis (TB) remains a leading cause of morbidity in developing nations, with cervical lymphadenopathy being the most common extrapulmonary manifestation. In resource-limited settings like Nepal, rapid and accurate diagnosis is critical for effective treatment. This study evaluates the diagnostic performance of two key modalities - ultrasound-guided fine-needle aspiration cytology (FNAC) and GeneXpert MTB/RIF assay - in patients with suspected tuberculous lymphadenitis.
Methods
We conducted a hospital-based comparative cross-sectional study at Bir Hospital, Nepal from February to June 2025. Sixty-two consecutive patients presenting with cervical lymphadenopathy underwent simultaneous ultrasound-guided FNAC and GeneXpert testing. FNAC smears were evaluated for cytomorphological features of TB, while GeneXpert detected Mycobacterium tuberculosis DNA and rifampicin resistance. A composite reference standard combining both tests was used for analysis. Diagnostic accuracy parameters including sensitivity, specificity, positive and negative predictive values were calculated. Agreement between tests was assessed using Cohen's kappa statistic.
Results: FNAC demonstrated superior sensitivity (93.1% vs 89.6%) while both tests showed perfect specificity (100%). The combined approach increased diagnostic yield by 7.4%, identifying additional cases that would have been missed by either test alone. Excellent agreement was observed between methods (?=0.902, p<0.001). Among 27 GeneXpert- positive cases, no confirmed rifampicin resistance was detected, though 14.8% showed indeterminate results. The majority of patients (58.1%) were aged 25-50 years, with a female predominance (59.7%).
Conclusions
Both ultrasound-guided FNAC and GeneXpert are highly accurate for diagnosing tuberculous lymphadenitis. Their complementary use enhances detection rates and should be adopted in high-burden settings. These findings support the integration of these diagnostic tools in the Nepalese TB control program to improve case detection and
treatment outcomes.
Keywords: extrapulmonary tuberculosis, lymphadenitis, Nepal, sensitivity and specificity, tuberculosis

ER  -