Comparison of fine needle aspiration with biopsy in the diagnosis of cutaneous leishmaniasis

Abstract

Background Leishmaniasis is a zoonotic infection caused by the protozoa belonging to the genusLeishmania. Demonstration of Leishman-Donovan (LD) bodies on histopathological examination ofbiopsy specimen is considered to be the definitive diagnostic modality. This study was designed toassess the diagnostic value of fine needle aspiration and to compare it with full thickness biopsy.Patients and methods This was randomized, open label comparison study conducted in departmentof dermatology, Pakistan Institute of Medical Sciences, Islamabad from 1st June 2007 to 31st July2007. 15 patients, 15 years of age or older were enrolled in the study. Selection of patients wasmade on the basis of clinical features. Patients with the lesions having typical clinical features ofcutaneous leishmaniasis-like erythematous crusted plaques or nodules were enrolled. Demographiccharacteristics including age, sex, residential address, site, size, shape and duration of lesions wasnoted. Informed consent was taken. Procedure and its pros and cons were explained to the patient.Procedure was performed in the FNA room of pathology department under strict aseptic conditions.Local anaesthesia was not given as patients tolerated the pain well. Biopsy specimen was taken fromthe same lesion under local anaesthesia after doing FNA. Slides were processed and examined. Thediagnosis was confirmed on the basis of finding giant cells or Leishman-Donovan bodies on FNA ofthe lesion.Results Out of 15 patients 12 patients had positive FNA and three patients had negative FNA report.While the biopsy specimen showed typical histopathological features of cutaneous leishmaniasis in14 out of 15 patients and one turned out to be a case of ruptured inclusion cyst. So out of 3 negativecases of FNA, one had ruptured inclusion cyst. The diagnostic rate was 80% for FNA and 93.3% forbiopsy.Conclusion Fine needle aspiration seems a reasonably good diagnostic modality for cutaneousleishmaniasis. Its sensitivity is comparable to that of full thickness biopsy.