Lymph node aspiration biopsy diagnostic reliability and limitations—an analysis of 350 cases

Abstract

The results of fine needle aspiration biopsy of lymph nodes in 350 patients and the modified biopsy technique used at our institution are discussed. Of the 350 cases, 209 aspirates were categorized as cytologically malignant, 102 as benign, 30 as suspicious for malignancy, and 9 as unsatisfactory. Cervical lymph nodes were most commonly sampled (58%), and supra-clavicular nodes were most likely to be malignant (90%). The overall diagnostic accuracy achieved was 94%. One false-positive and 9 (2%) false-negative results were observed in the 350 cases. In 3% of the 30 cases diagnosed as suspicious for malignancy, follow-up open biopsy of the lymph nodes in question proved them benign. The advantages and limitations of the procedure are discussed, as well as some of the possible sources of error, particularly in the diagnosis of lymphomas.

FNAC of Malignant Lymphoma in an Area with a High Incidence of T-cell Lymphoma

“…14,17,19 Kline et al 14 cy. In a study by Ramzy et al, 23 in which diagnostic accuracy of FNAC of malignancy of lymph nodes, including metastatic carcinoma and lymphoma, was investigated, the results was less accurate than those of the two previously mentioned studies.…”

“…The rates of aspiration of acellular material in FNAC of the lymph nodes vary; reports have included figures of 2.6%, 23 7.09%, 17 9%, 14 10.9%, 29 11.3% 27 and 11.9%. 3 Two reported rates of acellular aspirates in FNAC of NHL were 9.3% 28 and 11.4%, 19 and for Hodgkin's disease, rates of 10% 28 and 11.8% 22 have been reported.…”

“…14,[17][18][19]29 Although malignant lymphoma is not frequent among patients with lymphadenopathy, 17 the main diagnostic problem in FNAC of the lymph nodes, as can be seen from the data of Qizilbash et al, 22 is to differentiate between malignant lymphoma and benign lymphadenopathy. 11,17,22,23,29,32 The value of FNAC in the initial diagnosis of malignant lymphoma is controversial. 1,12,19 The difficulties in diagnosing malignant lymphoma by FNAC are due to the diversity of histologic features of malignant lymphoma and the presence of many subclassifications.…”

“…23 NHLs were classified according to the Rappaport classification 24 and the National Institutes of Healthsponsored International Working Formulation 25 ; Hodgkin's disease was classified histologically according to the Rye classification (1966).…”

Fine Needle Aspiration Cytology of Hodgkin’s Lymphoma

“…[1][2][3][4] In clinical practice it is routinely used to arrive at a diagnosis of both benign and malignant disorders. Its role in the diagnosis of either HL or non-HL, though debated in the past, has found widespread acceptance.…”