Diagnostic value of lymph node fine needle aspiration cytology: an institutional experience of 387 cases observed over a 5‐year period

Abstract

Lymph node fine needle aspiration (LNFNA) cytology is valuable in solving the diagnostic problems of clinical adenopathy. The usefulness of the procedure in the staging and diagnosis of various malignant and lymphoproliferative tumours, as well as its role in distinguishing reactive hyperplastic lymph nodes from lymphoma, has been documented in the literature generally on an individual basis. We report our cumulative 5 year experience of LNFNA representing 387 cases. Approximately half (n = 182) were diagnosed as either metastatic carcinoma or melanoma; in 54 cases (30%) excisional biopsy or tissue study was performed to confirm the diagnosis; there was only one false-positive diagnosis of a metastatic squamous carcinoma rendered on a submandibular lymph node. Sixty-one lymphoma cases were successfully diagnosed via LNFNA with no false positives; concurrent flow cytometry was utilized in 51% (n = 31) of the 61 cases and supported the cytologic diagnosis of lymphoma in 27 of the 31 cases (87%). A benign or reactive lymph node process was also diagnosed via LNFNA alone or in combination with flow cytometry in 48 cases with only five false negatives, which included four cases of mantle cell lymphoma and one case of melanoma. Unsatisfactory cases accounted for 12%, and represented specimens obtained by 'Wang needle' or other emerging techniques. Our study demonstrates that LNFNA can be an accurate, economical and rapid diagnostic procedure.

Rapid access multidisciplinary lymph node diagnostic clinic: analysis of 550 patients

“…A false-positive rate of 2.4% in our series for malignancy was high compared with other studies (0.2 -0.9%) (Steel et al, 1995;Nasuti et al, 2000). However, the proportion of nondiagnostic specimens of 10.4% was similar to another study (Nasuti et al, 2000). As fine-needle aspirations are operator-dependent, this shortfall in our FNAC accuracy could be partly explained by the lack of dedicated cytopathologists performing fine-needle aspirations at our clinic.…”

“…Adequate sampling and/or triage for further studies could thus be ensured. Many of these series, however, had a significant patient selection bias consisting entirely of patients with malignant lesions (Steel et al, 1995;Nasuti et al, 2000;Liu et al, 2001); therefore, results were strictly not comparable with ours.…”

“…In our series, a false-negative rate of 13.5% in FNAC was seen, mostly in lymphoid malignancies. A false-positive rate of 2.4% in our series for malignancy was high compared with other studies (0.2 -0.9%) (Steel et al, 1995;Nasuti et al, 2000). However, the proportion of nondiagnostic specimens of 10.4% was similar to another study (Nasuti et al, 2000).…”

“…Although the accuracy of diagnosing metastatic carcinoma in lymph nodes by fine-needle aspirations is in excess of 90% (Pangalis et al, 1993;Steel et al, 1995;Cha and Goates, 1996;Prasad et al, 1996;Nasuti et al, 2000), the accuracy of diagnosing primary lymphoma by fine-needle aspirations is only about 72% (Steel et al, 1995). However, with ancillary studies such as immunocytochemical phenotyping and/or flow cytometry, the accuracy of diagnosing haematopoietic conditions has been improved considerably (Nasuti et al, 2000;Liu et al, 2001). In our series, a false-negative rate of 13.5% in FNAC was seen, mostly in lymphoid malignancies.…”

Diagnostic value of liquid‐based cytology with fine needle aspiration specimens for cervical lymphadenopathy

“…However, as shown in the results, the nondiagnostic or unsatisfactory rate of CS cytology was thought to be as high as 11.9%. In the literature, the unsatisfactory rate in FNA with CS cytology of CLN ranges from 4.7% to 12% 22, 30. In some of the CS slides we prepared, cytological features such as air‐drying artifacts and unclear background of red blood cells resulted in a higher nondiagnostic or unsatisfactory rate.…”