Correlation of fine needle aspiration cytology lymph node with histopathological diagnosis

Abstract

INTRODUCTIONFine Needle Aspiration technique was described for the first time by Greig and Gray in 1904. Since the mid-1960's, it has been increasingly used and a high degree of accuracy has been achieved.l Lymphadenopathy is one of the commonest presenting symptoms of all age groups attending out door. The etiology can vary from simple inflammatory reactive lesion to a malignant condition.Therefore lymphadenopathy requires further evaluation. FNAC has been a suitable investigation to rule out malignancies and to confirm reactive or infective pathology.2,3 The use of fine needle aspiration cytology (FNAC) in the investigation of lymphadenopathy has become an acceptable and widely practiced minimally invasive technique, which is safe, relatively painless, simple and rapid. FNAC is highly cost effective and accurate as a first line investigative technique. With the recent advances in ultrasound and CT scan technologies, focal lesions can be aspirated using this procedures. 4 Fine needle aspiration cytology (FNAC) has emerged as an advanced diagnostic tool to differentiate reactive hyperplasia/inflammatory conditions, granulomatous disorders and lymphomas. This diagnostic modality has gained considerable importance in the management of patients with lymphadenopathy over several years. We are reporting histopathological correlation of 200 cases of lymphadenopathy with FNAC. ABSTRACTBackground: Lymphadenopathy is very common presenting symptoms. Fine needle aspiration cytology (FNAC) is used to evaluate the nature of the lesion. Etiology of lymphadenopathy in head and neck region vary from benign reactive hyperplasia to tubercular granulomatous lesion to malignancy. The aim of present study was to evaluate the sensitivity, specificity and predictive value in tuberculosis and metastatic carcinoma. Methods: A total of 80 patients out of 200 patients who underwent FNAC were evaluated by histopathological examination for correlation. Aspiration smears and histopathological slides were evaluated and results were calculated for sensitivity, specificity and predictive value. Results: Reactive lymphadenitis was seen in 40 patients followed by tubercular granulomatous lymphadenitis in 20 patients and malignant lesions in 20 patients. Histology revealed 18 patients of tubercular lymphadenitis, 43 of reactive changes, 12 of metastasis in lymph nodes and 7 of lymphomas. Correlating the findings, we could achieve 100% sensitivity and 96.7% specificity for tubercular lymphadenopathy and for metastatic it was 98.5% and 100% respectively. Conclusions: We have found FNAC a satisfactory tool in the diagnosis of tubercular and malignant lymphadenopathy. FNAC used in conjunction with clinical findings, radiological and laboratory investigations can be a cost effective method for the diagnosis of lymphadenopathy.

Fine Needle Aspiration Cytology– A Simple and Sensitive Diagnostic Tool in Management of Lymphadenopathy

“…A diagnostic test is considered satisfactory if its sensitivity and specificity are around 90%. In this study, the diagnostic accuracy of FNAC for nonspecific reactive lymphadenopathy was 97.1%, which was in agreement with the results of Gupta et al [14] who got 96.2% diagnostic accuracy, but it was much higher than that reported by Nasreen et al [15] (85%).…”

“…So in case of granulomatous lymphadenitis, the diagnostic sensitivity, specificity, positive predictive value and negative predictive value of FNAC was found to be 100%. The diagnostic efficiency of FNAC in case of granulomatous lymphadenitis was 100% in our study, while it was 70% and 97.5% in the experience of Nasreen et al [15] and Gupta et al [14] respectively. On examination of Auramine-rhodamine stained lymph node aspirate smears by fluorescent microscope under ultraviolet illumination, we could identify acid fast bacilli as bright fluorescing rods against a dark background in all the six cases (100%) of suppurative granulomatous lymphadenitis, while no bacilli could be demonstrated in chronic granulomatous lymphadenitis cases.…”

“…So in this study, the diagnostic sensitivity, specificity, positive predictive value and negative predictive value of FNAC as a diagnostic tool for detecting metastatic lymphadenopathy were found to be 93.7%, 98.1%, 93.7% and 98.1% respectively. The diagnostic efficiency of FNAC was 97.1% in our experience, while it was 100% and 98.75% in the experience of Nasreen et al [15] and Gupta et al [14] respectively.…”

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

“…2 Another study done by Gupta et al reported FNAC could achieve 100% sensitivity and 96.7% specificity for tubercular lymphadenopathy with positive predictive value to be 90% and negative predictive value to be 100%. 15 A study done by Deeva et al reported the sensitivity and specificity of FNAC for tuberculosis is 95.4% and 83.3%. and for chronic nonspecific lymphadenopathy is 93.75% and 96.66%.…”

Study of diagnostic accuracy of fine needle aspiration cytology of lymph nodes over 6 years in a tertiary care hospital

“…5 In another study from India, 100% sensitivity and 96.7% specificity was achieved for tubercular lymphadenopathy, and for metastatic disease it was 98.5% and 100% respectively. 6 In another large study from Egypt, the overall diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of FNAC of cervical lymph nodes were 90.9%, 67.2%, 82.6%, and 81.3%, respectively. 7 The overall diagnostic accuracy was 82.2%, while the overall discordance rate was 17.8%.…”