Spectrum of lymph node lesions on cytology in rural Haryana: a retrospective analysis

Puja Sharma, Shweta Rana, Manmeet Kaur Gill, Pawan Singh, Rahul N. Satarkar, Shivani Kalhan


Background: Fine Needle Aspiration Cytology (FNAC) is a simple, rapid, cost effective and reliable technique which can be used as a routine outpatient department (OPD) procedure and first line of investigation in diagnosing a variety of superficial and deep lesions. Lymphadenopathy is of great clinical significance and the underlying cause may range from a treatable infectious etiology to malignant neoplasms. In this study, we describe the diagnostic utility of FNAC in the assessment of lymph node lesions with an emphasis on the diagnosis of non-neoplastic, benign and malignant neoplastic processes. Cytomorphological patterns of tuberculous lymphadenitis were also observed.

Methods: This was a retrospective study and a total of 736 patients including all age groups and both sexes presenting with palpable or deep lymph nodes in FNAC clinic of our institute over a period of 2 years were included in our study. FNAC was conducted with 22-24 Gauge disposable needles attached to 20c.c syringes. Smears were fixed in 95% ethyl alcohol and stained with Papanicolaou stain. Leishman stain was done on air dried smears. Ziehl- Neelsen (ZN) staining was done wherever required.

Results: Out of 736 aspirations from lymph nodes, the most frequent cause of lymphadenopathy was found to be Tuberculosis with 419 cases (56.92%). The next frequent diagnosis was reactive lymphadenitis with 193 cases (26.22%) followed by metastatic lymphadenopathy in 47 cases (6.38%). A diagnosis of lymphoproliferative disorder was rendered in 20 cases (2.71%). In 10 cases (1.35%) FNAC was inconclusive.

Conclusion: In our study, the predominant cause of lymphadenopathy was tuberculous lymphadenitis, seen in more than half of total cases, followed by reactive lymphadenopathy and malignant neoplasms. FNAC was helpful in establishing the diagnosis in 98.65% of the cases.



FNAC, Lymphadenopathy, Tuberculous lymphadenitis, Metastatic lymphadenitis

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Darnal HK, Karim N, Kamini K, Angela K. The Profile of lymphadenopathy in adults and children. Med J Malaysia. 2005;60:590-8.

Pandit AA, Candes FP, Khubchandini SR. Fine needle cytology of lymph nodes. J Postgrad Med. 1987;33:134-6.

Pavithra P, Geetha JP. Role of fine needle aspiration cytology in the evaluation of the spectrum of lymph node lesions. Int J Pharm Bio Sci. 2014;5(4):377-84.

Ajmal I, Imran A. Comparison of FNAC vs. excision biopsy for suspected tuberculous cervical lymphadenopathy. Ann King Edward Med Coll. 2003;9:216-8.

Shrivastav A, Shah HA, Shrivastav G, Santwani PM. Utility of acid-fast staining and re-aspiration in tubercular lymphadenopathy - 3 year study at tertiary centre. Int J Med Sci Public Health. 2013;2:875-9.

Fatima S, Arshad S, Ahmed Z, Hasan SH. Spectrum of cytological findings in patients with Neck lymphadenopathy - experience in a tertiary hospital in Pakistan. Asian Pac J Cancer Prev. 2011;12:1873-5.

Cohen MB, Miller TR, Bottles K. Classics in cytology: note on fine needle aspiration of lymphatic glands in sleeping sickness. Acta Cytol. 1986;30(4):451-2.

Singh JP, Chaturvedi NK, Das A. Role of Fine needle aspiration cytology in the diagnosis of tuberculous lymphadenitis. Indian J Pathol Microbiol. 1989;32:100-4.

Dukare SR, Jadhav DS, Gaikwad AL, Ranka SN, Kale PB, D’Costa G. Fine needle aspiration cytology of cervical lymphadenopathy - a study of 510 cases. Asian J Sci Technol. 2014;5(9):537-40.

Pandav AB, Patil PP, Lanjewar DN. Cervical lymphadenopathy diagnosis by FNAC: a study of 219 cases. Asian J Med Res. 2012;1(3):79-83.

Rajshekaran S. Tuberculous cervical lymphadenitis in HIV positive and negative patients. Indian J Tuberc. 2001;48:201-4.

Chandanwale S, Buch A, Verma A, Shruthi V, Kulkarni S, Satav V. Evaluation of granulomatous lymphadenitis on fine needle aspiration cytology - diagnostic dilemma. Int J Pharm Bio Sci. 2014;5(4):377-84.

Kochhar AK, Duggal G, Singh K, Kochhar SK. Spectrum of cytological findings in patients with lymphadenopathy in rural population of South Haryana, India - experience in a tertiary care hospital. Internet J Pathol. 2012;13(2):8.

Mohanty R, Wilkinson A. Utility of fine needle aspiration of lymph nodes. IOSR J Dent Med Sci. 2013;8(5):13-8.

Ahmed SS, Akhtar S, Akhtar K, Naseem S, Mansoor T, Khalil S. Incidence of Tuberculosis from study of Fine- Needle Aspiration Cytology in Lymphadenopathy and Acid- Fast Staining. Indian J Community Med. 2005;30(2):63-6.

Chand P, Dogra R, Chauhan N, Gupta R, Khare P. Cytological pattern of tubercular lymphadenopathy on FNAC: analysis of 550 consecutive cases. J Clin Diagn Res. 2014;8(9):FC16-9.

Khajuria R, Goswami KC, Singh K, Dubey VK. Pattern of lymphadenopathy on fine needle aspiration cytology in Jammu. JK Sci. 2006;8(3):157-9.

Das DK. Fine needle aspiration cytology in the diagnosis of tuberculous lesions. Lab Med. 2003;31(11):625-32.

Bezabih M, Marian DW, Selassie SG. Fine needle aspiration cytology of cervical lymphadenopathy with special reference to tuberculosis. J Indian Med Assoc. 1994;92:44-6.

Paliwal N, Thakur S, Mullick S, Gupta K. FNAC in tuberculous lymphadenitis: experience from a tertiary level referral centre. Indian J Tuberc. 2011;58:102-7.

Aggarwal P, Wali JP, Singh S, HandaR, Wig N, Biswas A. A clinico bacterial study of Peripheral tuberculous lymphadenitis. J Assoc Physicians India. 2001;49:808-12.

Bhardwaj K, Goyal T, Bhardwaj BL. Fine needle aspiration cytology in lymph node disorders with special reference to tuberculosis. J Cytol. 2000;17(3):155-9.

Lau SK, Wei WI, Hsu C, Engzell UCG. Efficacy of fine needle aspiration cytology in the diagnosis of tuberculous cervical lymphadenopathy. J Laryngol Otol. 1990;104(1):24-7.

Paul PC, Goswami BK, Chakrabarti S, Giri A, Pramnik R. Fine needle aspiration cytology of lymphnodes - an institutional study of 1448 cases over a five year period. J Cytol. 2004;21:187-90.

Finfer M, Perchick A, Barstein DE. Fine needle aspiration biopsy diagnosis of syndrome. Tuberculous lymphadenitis in patients with and without the acquired immune deficiency. Acta Cytol. 1991;35:325-32.

Khan AH, Hayat AS, Baloch GH, Jaffery MH, Soomro MA, Siddiqui S. Study of FNAC in cervical lymphadenopathy. World Appl Sci J. 2011;12(11):1951-4.

Hirachand S, Lakhey M, Akhter J, Thapa B. Evaluation of fine needle aspiration cytology of lymph nodes in Kathmandu medical college teaching hospital. Kathmandu Univ Med J. 2009;7:139-42.

Adhikari P, Sinha BK, Baskota DK. Comparison of fine needle aspiration cytology and histopathology in diagnosing cervical lymphadenopathies. Australas Med J. 2011;4:97-9.

Patra AK, Nanda BK, Mahapatra BVK, Panda AK. Diagnosis of lymphadenopathy by fine needle aspiration cytology. Indian J Pathol Microbiol. 1983;26:272-8.

Bhaskaran CS, Kumar GH, Sreenivas M, Kamleshwari R, Rao G, Aruna CA. Fine needle aspiration cytology review of 1731 cases. Indian J Pathol Microbiol. 1990;83:387-97.

Hafez NH, Tahoun NS. Reliability of fine needle aspiration cytology (FNAC) as a diagnostic tool in cases of cervical lymphadenopathy. J Egypt Natl Cancer Inst. 2011;23:105-14.