The diagnostic pathway to a surgical lymph node excision biopsy service in a HIV and TB endemic region in a Western Cape Tertiary Institution

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dc.contributor.advisorVerburgh, Estelle
dc.contributor.advisorMalherbe, Francois
dc.contributor.authorPotelwa, Tennis Tomo Camagu
dc.date.accessioned2026-01-16T09:50:29Z
dc.date.available2026-01-16T09:50:29Z
dc.date.issued2025
dc.date.updated2026-01-15T13:02:43Z
dc.description.abstractIn the HIV/TB endemic public care setting of the Western Cape, diagnostic consideration of patients with persistent lymphadenopathy is focused towards extra- pulmonary tuberculosis (EPTB), more than other infectious or malignant causes of lymphadenopathy. We investigated patients consecutively referred for lymph node excision at Groote Schuur Hospital for selection of, and results of, laboratory tests performed during the diagnostic pathway and possible impact on diagnostic delay. Eighty-six patients were included, 61 patients (71%) had no previous diagnosis to explain the lymphadenopathy, while 25 patients had a previous diagnosis of a haematological malignancy, cancer or tuberculosis. In the new patient group, EPTB was the commonest diagnostic outcome (24.6%, 15/61), followed by lymphoma (21.3%, 13/61) and cancer (14.8%, 9/61). HIV positive patients constituted 41% (n=25). Median time from presentation with lymphadenopathy to first excision biopsy was 55 days (IQR 22-106). Fine needle aspiration (FNA) cytology of lymphadenopathy was performed in 30/61 (49%) of patients and repeated in a third of these, while smear for AFBs and culture for M. tuberculosis were infrequently performed and GeneXpert MTB/RIF assay on FNA never performed. Furthermore, in the seven patients with a final diagnosis of lymphoma in whom FNA cytology was performed, cytology was not diagnostic of lymphoma. In patients with persistent lymphadenopathy, this study demonstrates how poorly structured diagnostic pathways contribute to unnecessary health care utilisation and diagnostic delay in readily treatable conditions. We need to implement accurate diagnostic pathways for patients with lymphadenopathy in South Africa's healthcare system, thus improving early diagnosis of both EPTB and lymphoma, potentially improving patient outcomes.
dc.identifier.apacitationPotelwa, T. T. C. (2025). <i>The diagnostic pathway to a surgical lymph node excision biopsy service in a HIV and TB endemic region in a Western Cape Tertiary Institution</i>. (). University of Cape Town ,Faculty of Health Sciences ,Department of Medicine. Retrieved from http://hdl.handle.net/11427/42584en_ZA
dc.identifier.chicagocitationPotelwa, Tennis Tomo Camagu. <i>"The diagnostic pathway to a surgical lymph node excision biopsy service in a HIV and TB endemic region in a Western Cape Tertiary Institution."</i> ., University of Cape Town ,Faculty of Health Sciences ,Department of Medicine, 2025. http://hdl.handle.net/11427/42584en_ZA
dc.identifier.citationPotelwa, T.T.C. 2025. The diagnostic pathway to a surgical lymph node excision biopsy service in a HIV and TB endemic region in a Western Cape Tertiary Institution. . University of Cape Town ,Faculty of Health Sciences ,Department of Medicine. http://hdl.handle.net/11427/42584en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Potelwa, Tennis Tomo Camagu AB - In the HIV/TB endemic public care setting of the Western Cape, diagnostic consideration of patients with persistent lymphadenopathy is focused towards extra- pulmonary tuberculosis (EPTB), more than other infectious or malignant causes of lymphadenopathy. We investigated patients consecutively referred for lymph node excision at Groote Schuur Hospital for selection of, and results of, laboratory tests performed during the diagnostic pathway and possible impact on diagnostic delay. Eighty-six patients were included, 61 patients (71%) had no previous diagnosis to explain the lymphadenopathy, while 25 patients had a previous diagnosis of a haematological malignancy, cancer or tuberculosis. In the new patient group, EPTB was the commonest diagnostic outcome (24.6%, 15/61), followed by lymphoma (21.3%, 13/61) and cancer (14.8%, 9/61). HIV positive patients constituted 41% (n=25). Median time from presentation with lymphadenopathy to first excision biopsy was 55 days (IQR 22-106). Fine needle aspiration (FNA) cytology of lymphadenopathy was performed in 30/61 (49%) of patients and repeated in a third of these, while smear for AFBs and culture for M. tuberculosis were infrequently performed and GeneXpert MTB/RIF assay on FNA never performed. Furthermore, in the seven patients with a final diagnosis of lymphoma in whom FNA cytology was performed, cytology was not diagnostic of lymphoma. In patients with persistent lymphadenopathy, this study demonstrates how poorly structured diagnostic pathways contribute to unnecessary health care utilisation and diagnostic delay in readily treatable conditions. We need to implement accurate diagnostic pathways for patients with lymphadenopathy in South Africa's healthcare system, thus improving early diagnosis of both EPTB and lymphoma, potentially improving patient outcomes. DA - 2025 DB - OpenUCT DP - University of Cape Town KW - HIV KW - TB KW - Western Cape KW - Tertiary Institution LK - https://open.uct.ac.za PB - University of Cape Town PY - 2025 T1 - The diagnostic pathway to a surgical lymph node excision biopsy service in a HIV and TB endemic region in a Western Cape Tertiary Institution TI - The diagnostic pathway to a surgical lymph node excision biopsy service in a HIV and TB endemic region in a Western Cape Tertiary Institution UR - http://hdl.handle.net/11427/42584 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/42584
dc.identifier.vancouvercitationPotelwa TTC. The diagnostic pathway to a surgical lymph node excision biopsy service in a HIV and TB endemic region in a Western Cape Tertiary Institution. []. University of Cape Town ,Faculty of Health Sciences ,Department of Medicine, 2025 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/42584en_ZA
dc.language.isoen
dc.language.rfc3066eng
dc.publisher.departmentDepartment of Medicine
dc.publisher.facultyFaculty of Health Sciences
dc.publisher.institutionUniversity of Cape Town
dc.subjectHIV
dc.subjectTB
dc.subjectWestern Cape
dc.subjectTertiary Institution
dc.titleThe diagnostic pathway to a surgical lymph node excision biopsy service in a HIV and TB endemic region in a Western Cape Tertiary Institution
dc.typeThesis / Dissertation
dc.type.qualificationlevelMasters
dc.type.qualificationlevelMMed
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