Utility of the Proposed Sydney System for Classification of Fine-Needle Aspiration Cytopathology of Lymph Node: A Retrospective Study at a Tertiary Care Center

Kanhe, Rucha; Santosh, Tummidi; Kothari, Kanchan; Agnihotri, Mona

doi:10.1159/000530984

Cited by 6 publications

(4 citation statements)

References 24 publications

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“…In May 2019, During the International Congress of Cytology in Sydney, a systems approach was proposed for the classification, reporting, and execution of lymph node cytology [8,9,16,17]. Their main aim was to develop a common language and to help cytopathologists, hematopathologists, physicians, surgeons, and other medical professionals communicate more effectively, establish consensus criteria and a reference framework.…”

Section: Discussionmentioning

confidence: 99%

“…One of the biggest obstacles in lymph node cytology is the lack of a universally accepted terminology for reporting lymph node FNA cytology results [6]. This is among the reasons for lymph node FNA has not gained widespread support from medical practitioners and oncologists, despite its minimum invasiveness, low cost, and quickness [1,3,7,8]. 2 At the 20th International Congress of Cytology in Sydney in May 2019, an expert group released the Sydney system proposal for lymph node cytopathology categorization and reporting [9].…”

Section: Introductionmentioning

confidence: 99%

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Sydney Reporting System for Lymph Node Fine Needle Aspiration and Malignancy Risk Stratification, Is it of Clinical Value?

Alqaidy

2024

Preprint

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Lymphadenopathy is a common manifestation of both reactive and malignant diseases, and fine needle aspiration (FNA) is an effective and inexpensive screening method. It can prevent unnecessary invasive surgery and excisional biopsy, especially in benign cases. Unfortunately, the lack of universally accepted terminology for reporting results has hindered its widespread support. The Sydney system proposal for lymph node cytopathology categorization and reporting introduced five diagnostic categories to address the lack of universally accepted terminology for reporting results in lymphadenopathy. Our study analyzed 188 lymph node FNC samples from King Abdulaziz University Hospital, Saudi Arabia, examining clinical follow-up data, pathology records, patient information, and final diagnosis from January 2019 to December 2022. Most specimens were from axillary LNs, with 99.5% tissue correlation. The Sydney System Category classification identified 56.9% of cases as malignant, while 26.1% were benign. The final surgical specimen diagnosis revealed a higher percentage of malignant diagnoses, with the highest ROM in malignant/Category V. In conclusion, our study demonstrates that LN-FNAC offers high diagnostic accuracy for LN aspirates, with the Sydney approach potentially aiding risk stratification and achieving consistency in cytologic diagnosis, but further multi-centric research is needed.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Sydney Reporting System for Lymph Node Fine Needle Aspiration and Malignancy Risk Stratification, Is it of Clinical Value?

Alqaidy

2024

Preprint

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“…c Forest plot for the AUC with the results of fixed and random-effects meta-analysis for the accuracy when the "malignant" category was considered positive for malignancy. [4] 0.97 0.0128 0.945-0.995 Caputo, 2022 [5] 0.95 0.0102 0.930-0.970 Ahuja, 2022 [6] 0.96 0.0102 0.940-0.980 Uzun, 2022 [7] 0.99 0.00765 0.975-1.000 Kanhe, 2023 [8] 0.99 0.00765 0.975-1.000 Juanita, 2023 [9] 0.9 0.0255 0.850-0.950 Balasubramanian, 2023 [10] 0 [4] 0.93 0.0179 0.895-0.965 Caputo, 2022 [5] 0.95 0.0102 0.930-0.970 Ahuja, 2022 [6] 0.72 0.0255 0.670-0.770 Uzun, 2022 [7] 0.79 0.0204 0.750-0.830 Kanhe, 2023 [8] 0.95 0.0102 0.930-0.970 Juanita, 2023 [9] 0.85 0.0306 0.790-0.910 Balasubramanian, 2023 [10] 0 Likelihood ratio scatter matrices for the different diagnostic thresholds. The points represent the studies and are numbered according to the order given in Table 1.…”

Section: Statement Of Ethicsmentioning

confidence: 99%

“…The categories of the Sydney system include I/L1: nondiagnostic; II/L2: benign; III/L3: atypical cells of undetermined significance or atypical lymphoid cells of uncertain significance; IV/L4: suspicious of malignancy; and V/L5: malignant [1]. Following its development, a large number of studies have been done to predict the usefulness of the Sydney system in the diagnosis of lymph node aspirates [2][3][4][5][6][7][8][9][10]. However, a precise estimate of sensitivity (SN) and specificity, which is a systematic review and meta-analysis of the diagnostic accuracy of the Sydney system, in the diagnosis of lymph node aspirates is lacking.…”

Section: Introductionmentioning

confidence: 99%

Systematic Review and Meta-Analysis of the Diagnostic Accuracy of the Sydney System for Reporting Lymph Node Fine-Needle Aspiration Biopsy in Diagnosing Malignancy

Ahuja,

Aziz Khan,

Ahuja

et al. 2023

Acta Cytologica

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Introduction To perform the first meta-analysis for assessment of the pooled risk of malignancy of each category of the Sydney system for reporting of lymph nodal aspirates along with evaluation of diagnostic accuracy. Methods Pubmed/ MEDLINE and Embase were searched with the following keywords “(Lymph node) AND ("fine needle aspiration biopsy" OR FNAB) OR (International system OR Sydney system)” in the timeframe 2020 to August 04, 2023. The selected articles were assessed for risk of bias by the QUADAS-2 tool. The meta-analysis for sensitivity and specificity for each cut-off, that is, “Atypical considered positive,” “Suspicious of Malignancy considered positive,” and “Malignant considered positive” for the lesions was carried out after excluding the inadequate samples in each study. To assess the diagnostic accuracy, summary receiver operating characteristic (sROC) curves were constructed, and the diagnostic odds ratio (DOR) was pooled in both scenarios. Results Nine studies, all of which were retrospective cross-sectional studies were evaluated with a total of 13205 cases. The sensitivity and specificity for the “Atypical and higher risk categories” considered as positive for malignancy were 97% (95% CI, 95%-99%), and 96% (95% CI, 91%-98%) respectively. The sensitivity and specificity for the “Suspicious for malignancy and higher risk categories” considered as positive for malignancy were 91% (95% CI, 85%-95%), and 99% (95% CI, 97%-100%) respectively. The sensitivity and specificity for the “Malignant” considered as positive for malignancy were 75% (95% CI, 65%-84%), and 100% (95% CI, 99%-100%) respectively. The pooled Area under the curve was 99-100% for each of the cut-offs. Conclusion This meta-analysis highlights the accuracy of the Sydney system in reporting lymph node aspirates. It exhibits the significance of the “Suspicious” and “Malignant” categories in diagnosing malignancy and of the “ Benign” category in excluding malignancy.

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The Sydney system for lymph node FNA biopsy cytopathology: A detailed analysis of recent publications and meta‐analysis and a proposal for the components of an ideal prospective study of a cytopathology reporting system

Liang,

Cozzolino,

Zeppa

et al. 2024

Cancer Cytopathology

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BackgroundThe Sydney system for fine‐needle aspiration biopsy of lymph nodes has five categories, stressing the role of correlation of cytopathology with clinical, ultrasound, and ancillary findings to achieve diagnosis. The five categories constitute a hierarchical system with increasing risk of malignancy from benign to atypical, suspicious, and malignant categories, which informs recommendations for further workup to achieve a final diagnosis as possible. This article analyzes 10 publications using the Sydney system and a meta‐analysis of nine of these studies. The primary goal of the analysis is to ascertain the causes of the large ranges in risk of malignancy for the “atypical” and “inadequate” compared to “benign,” “suspicious,” and “malignant” categories, which were comparable to well‐established reporting systems. Research protocols are proposed to improve future studies.MethodsPubMed literature search from January 2021 to December 2023 identified studies evaluating performance of the Sydney system.ResultsTen studies showed heterogeneity with clinical setting, study design, ultrasound use and rapid on‐site evaluation, operator, cutoff points for “positive” cases, with inherent partial verification biases, resulting in a wide range of risk of malignancy, specificity, and sensitivity values.ConclusionAnalysis shows the large range is due to heterogeneity of the studies, which suffer from biases and variable statistical analysis that are ultimately included in any meta‐analysis, detracting from the usefulness of the risk of malignancy derived by the meta‐analysis. Components for ideal analyses of reporting systems are presented.

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Utility of the Proposed Sydney System for Classification of Fine-Needle Aspiration Cytopathology of Lymph Node: A Retrospective Study at a Tertiary Care Center

Cited by 6 publications

References 24 publications

Sydney Reporting System for Lymph Node Fine Needle Aspiration and Malignancy Risk Stratification, Is it of Clinical Value?

Sydney Reporting System for Lymph Node Fine Needle Aspiration and Malignancy Risk Stratification, Is it of Clinical Value?

Systematic Review and Meta-Analysis of the Diagnostic Accuracy of the Sydney System for Reporting Lymph Node Fine-Needle Aspiration Biopsy in Diagnosing Malignancy

The Sydney system for lymph node FNA biopsy cytopathology: A detailed analysis of recent publications and meta‐analysis and a proposal for the components of an ideal prospective study of a cytopathology reporting system

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