Fine‐needle aspiration of superficial and deeply seated lymph nodes on patients with and without a history of malignancy: Review of 439 cases

Abstract

This study addresses the utility of fine-needle aspiration (FNA) in assessing lymphadenopathy in patients with and without a previous history of malignancy. We reviewed the FNAs of superficial and deeply seated lymph nodes performed at our institution over a period of 18 yr (1983-2001). Where applicable, we also reviewed and report here the results of subsequent surgical excisional biopsies. We analyzed data from 439 patients, who ranged in age from 1 to 90 yr. The neck and retroperitoneum were the most frequently sampled sites (47% and 25%, respectively). Among the 439 FNAs, adequate material was obtained in 421 cases (96%); the remaining 18 were unsatisfactory (4.1%). Malignant diagnoses were rendered in 330 cases (75% of 439), four were suspicious for lymphoma (0.9%), and 87 were read as reactive lymph nodes or granulomas (20%). The most common malignant cytologic diagnoses from these lymph node FNAs were adenocarcinoma, squamous cell carcinoma, and lymphoma. We compared results between two major groups: patients with a history of malignancy and those without. FNA showed malignancy in 87% of patients with a history of cancer and 41% without such a history. Thirty-three or 10% of patients with a history of malignancy were given a benign diagnosis and follow-up surgical excisional biopsies were performed in nine of these cases. Four of the nine showed low-grade lymphoma. Of the 18 non-diagnostic FNAs, nine came from patients with a history of malignancy and in six of these nine who had a follow-up surgical excisional biopsy the lymph nodes were positive for malignancy. Of the other nine, who had no history of malignancy, only two had follow-up biopsies and both of these were negative. Patients with a history of malignancy are more than twice as likely to show malignancy on lymph node FNA compared to those without such a history (87% vs. 41%). Knowing whether a patient has a history of malignancy provides the appropriate level of suspicion for ordering ancillary investigations or even recommending excisional biopsy for further evaluation.

Diagnostic Biopsy of Lymph Nodes of the Neck, Axilla and Groin: Rhyme, Reason or Chance?

“…This raises the question whether this diagnosis could have been made on other, non-surgical grounds, such as clinical judgement, cytological analysis [30][31][32][33] or by ultrasound scanning which is becoming an increasingly sophisticated and accurate diagnostic tool. [34][35][36][37] The negative biopsy rate was particularly high amongst children (30 of 34; 85%), a group on whom unnecessary or inappropriate surgery should particularly be avoided.…”

“…Following history taking and close examination of the area of nodal drainage and of other lymph node sites, performed by a clinician knowledgeable of locoregional disease processes, any suspicious node is subjected to fine needle aspiration cytology. [30][31][32][33] A normal full blood count excludes those patients with chronic lymphatic leukaemia presenting with lymphadenopathy. In the younger adult with neck nodes, screening for infectious mononucleosis, cat scratch disease and toxoplasmosis helps exclude these diseases that clinically can mimic a lymphoma.…”

Pattern of Lymphadenitis as Detected by Fnac in a Hospital Based Study on the West Lucknow Population.

“…The cytological criteria for the diagnosis of possible tubercular lymphadenitis is epithelioid cell granulomas with or without multinucleated giant cells and presence or absence of caseating necrosis [4].It should be kept in mind that lymphadenopathy is the most common presentation of extra pulmonary tuberculosis [6,7]. Pediatric cervical lymphadenopathy is a challenging medical condition for the patient, the parent, and the physician.…”

“…Most of metastatic carcinoma can be identified by their cytomorphological characteristics alone. However biopsy still remains important in accurate and definite diagnosis of a tumor [6]. Cytoimmunochemistry is opening up newer doors for diagnostic cytopathology specially in the field of oncology [7].…”

Clinicopathological Correlation of Fine Needle Aspiration Cytology With Histopathology in Peripheral Lymphadenopathy in Patients Attending a Tertiary Care Hospital in Eastern Bihar

“…12,13 In 1991, Silverman and Colleagues examined 135 FNA specimens from multiple sites in children. FNAC showed sensitivity of 90.6% and specificity of 100% and positive predictive value of 100%.…”