Cervical lymphadenopathy: a clinicopathological study

Abstract

INTRODUCTIONThe term lymphadenopathy refers to nodes that are abnormal in size, shape, consistency or number.1 Cervical lymphadenopathy is one of the commonest presentations of underlying pathology of the head and neck region which has large number of differential diagnosis like neoplasms, infections (specific and non-specific), in immune deficiency disorders and also in rare disorders like inflammatory pseudotumour (plasma cell granuloma) and Kikuchi-Fujimoto disease. Various diagnostic modalities like fine needle aspiration cytology, ultrasonography (USG), computerized tomography and PET CT neck are now available to diagnose underlying disease in cervical lymphadenitis. These investigating tools have high sensitivity and specificity for cervical lymphadenopathy. The standard modality in the workup of a neck mass is fine needle aspiration (FNA). FNA can be used for both cytology and culture (in cases in which a suspected infectious neck mass does not respond to conventional antibiotic therapy). If FNA is unsuccessful or if sufficient information is not obtained from an initial FNA, the FNA should be repeated before open biopsy. 2Aetiology and clinical presentation of cervical lymphadenopathy is certainly different in different groups of population. Understanding prevalent conditions and ABSTRACT Background: Cervical lymphadenopathy is one of the commonest presentations of underlying pathology of the head and neck region which has large number of differential diagnosis like neoplasms, infections (specific and nonspecific), immune deficiency disorders and rare disorders like Inflammation. Pseudotumour (plasma cell granuloma) and Kikuchi-Fujimoto disease. Methods: The present study is a prospective study conducted in our institution Dr B.A.M. Central Railway Hospital, Mumbai. Our study included 115 patients with cervical lymphadenopathy presenting with swelling of more than 1.5 cm size in longest diameter. All the patients included in our study are more than 12 years of age, in whom the lymph node did not regress after adequate antibiotic therapy in acute cases (i.e. Conservative management for at least 2 week), and all the chronic cervical lymphadenopathy patients. Results: Tuberculosis was found to be the most common cause of cervical Lymphadenopathy in 54.78% cases followed by reactive lymphadenitis in 22.61% cases, chronic nonspecific lymphadenitis in 12.17% cases and metastatic lymphadenopathy in 7.83% cases. Other causes were unknown primary in 1.74% cases and non-Hodgkin's lymphoma in 0.87% cases. Sensitivity and specificity of FNAC was 79.36% and 100% respectively. Conclusions: Tuberculosis, reactive lymphadenitis and malignancy are the most important cause of cervical Lymphadenopathy. They present in different age groups with different clinical feature. Fine Needle Aspiration Cytology (FNAC) is extremely sensitive and highly specific investigation for early diagnosis.

Clinical profile of cervical lymphadenopathy and to find diagnostic efficacy of fine-needle aspiration cytology, ultrasonography and histopathological examination

“…Similarly, Kartikranjan et al concluded that the sensitivity and specificity of FNAC for diagnosing tuberculous lymphadenitis is therefore 86% and 100% respectively. 17 In our study, sensitivity of FNAC was 91.1%, in a study done by Motiwala et al 6 Sensitivity of FNAC in diagnosis of tuberculosis was found to be 79.36% whereas specificity was found to be 100%.…”

“…Upper jugular group (level-2) was the commonest to get involved in tuberculosis (30.76%) which was reported by Mili et al 2 Motiwala et al reported submandibular nodes involved in 51 cases (44.35%), upper deep cervical nodes (level 2) were involved in 48 cases (41.74%), middle deep cervical in 39 cases (33.91%), lower deep cervical node in 9 cases (7.83%), and posterior group of nodes in 15 cases (13.04%). 6 Gorle et al reported posterior triangle of neck as commonly involved in tubercular etiology followed by level 2 (21.5%). 13 In our present study sensitivity of FNAC to diagnose chronic granulomatous lymphadenitis was 68.4%, specificity was 91.3%, positive predictive value was 92.9%, negative predictive value is 63.6%, accuracy is 77%.…”

“…Level 2 (upper jugular nodes) was the most common level of cervical lymph node involvement. 6 Majority of the cases presented before 6 months' duration with average duration of complaint is 249.3 days.…”

“…4 In case FNAC is ineffective or in case adequate material is not acquired from a preliminary FNAC, the FNAC should be carried out again earlier to undertaking open biopsy. 5,6 As compared to physical examination, imaging can pinpoint the dimension and distribution of the node more precisely. For the purposes of assessing lymph nodes in superficial such regions as the neck, ultrasound is a noninvasive technique.…”

Clinicopathological study and management of infective swellings of neck in pediatric age group patients

“…In current study, fever (52%) is the most common associated presenting complaint. Similar findings were [13][14][15] Studies among paediatric neck masses done by Showkat et al, Govari et al, Deeva et al, Cannolly et al and Gangwar et al found that reactive lymphadenopathy is the most common infective neck swelling. 2,13,[16][17][18] Similar findings noted in current study 46% (N=47) are reactive lymphadenitis cases.…”