Evaluation of fine needle aspiration cytology as the initial diagnostic test in cases of cervical lymphadenopathy

Authors

  • Gunjan P. Upadhyay Department of TB and Chest, G. M. E. R. S. Medical College, Gandhinagar, Gujarat, India
  • Rameshchandra M. Thakker Department of TB and Chest, G. M. E. R. S. Medical College, Gandhinagar, Gujarat, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20164066

Keywords:

Cervical lymph node, FNAC, Malignancy, Tuberculosis

Abstract

Background: Cervical lymph node enlargement is common amongst the various causes of neck swelling. Proper diagnosis and early treatment is necessary for cervical lymph node disease and it is also necessary to rule out potentially curable causes as against malignancy in which the treatment is generally palliative. Fine needle aspiration cytology (FNAC) is now a day the initial investigation in most of the cases of cervical lymph node enlargement. Aims and Objectives of the study were to evaluate the sensitivity and specificity of FNAC in the diagnosis of cervical lymph node disease with an emphasis on discordant cases between the cytology and the histopathology.

Methods: Patients admitted with cervical lymph node enlargement in a tertiary hospital of western India (attached with a medical college) from October 2014 to September 2016 were prospectively studied. Detailed history, clinical examination and necessary investigations of all patients were done especially fine needle aspiration cytology and histopathology examination and inference was obtained after the diagnosis was confirmed.

Results: The cytological diagnoses were found to be malignant in 48 cases (30.6%) and benign in 109 cases (69.4%). The overall diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of FNAC of cervical lymph nodes were 90.9%, 67.2%, 82.6%, and 81.3%, respectively. The overall diagnostic accuracy was 82.2%, while the overall discordance rate was 17.8%.

Conclusions: FNAC is the initial investigation of choice in the diagnostic approach to most of the cases of cervical lymphadenopathy and it has good diagnostic sensitivity and specificity.

References

Bloch M. (Anderson, J. E., trans), The Royal Touch: Sacred Monarchy and Scrofula in England and France (Les Rois Thaumaturges), Routledge & Kegan Paul, London. 1973;61(2).

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(26):139-42.

Kollur SM, El Hag IB. Fine needle aspiration cytology of metastatic nasopharyngeal carcinoma in cervical lymph nodes: comparison with metastatic squamous cell carcinoma and Hodgkin’ and Non Hodgkin’ lymphoma. Diagn Cytopathol. 2003;28:18-22.

Kent DC. Tuberculous lymphadenitis: not a localized disease process. Am J Med Sci. 1967;254:866.

Aaron L, Saadoun D, Calatroni I, Launay O, Mémain N, Vincent V, et al. Tuberculosis in HIV-infected patients: a comprehensive review. Clin Microbiol Infect. 2004;10:388-98.

Manolidis S, Frenkiel S, Yoskovitch A, Black M. Mycobacterial infections of the head and neck. Otolaryngol Head Neck Surg. 1993;109:427-33.

Das DK. Value and limitation of fine-needle aspiration cytology in diagnosis and classification of lymphomas: a review. Diagn Cytopathol. 1999;21:240-9.

Bagwan IN, Kane SV, Chinoy RF. Cytologic evaluaton of the enlarged neck node: FNAC utility in metastatic neck disease. Int J Pathol. 2007;6:2.

Al-Mulhim AS, Al-Ghamdi AM, Al-Marzooq HM, Mohammad HA, Gharib IA. The role of fine needle aspiration cytology and imprint cytology in cervical lymphadenopathy. Saudi Med J. 2004;25:862-5.

Haque MA, Talukder SI. Evaluation of fine needle aspiration cytology of lymph node in Mymensingh. Mymensingh Med J. 2003;12(1):33-5.

Tilak V, Dhadel AV, Jain R. Fine needle aspiration cytology of the head and neck masses. Ind J Pathol Microbiol. 2002;45(1):23-30.

Ahmad SS, Akhtar S, Akhtar K, Naseen S, Mansoor T. Study of fine needle aspiration cytology in lymphadenopathy with special reference to acid fast staining in cases of tuberculosis. J K Sci. 2005;7(1):1-4.

Sarda AK, Bal S, Singh MK, Kapur MM. Fine needle aspiration cytology as a preliminary diagnostic procedure for asymptomatic cervical lymphadenopathy. JAPI. 1990;38(3):46-9.

AlAlwan NA, AlHashimi AS, Salman MM, AlAttar EA. Fine needle aspiration cytology versus histopathology in diagnosing lymph node lesions. East Mediterr Health J. 1996;2(2):320-5.

Alam K, Khan A, Siddiqui F, Jain A, Haider N. Fine needle aspiration cytology, a handy tool for metastatic lymphadenopathy. Internet J Pathol. 2010;10(2).

Keith VE, Harsharan SK, Jerald GZ. Fine needle aspiration biopsy of lymph nodes in the modern era: reactive lymphadenopathies. Pathol Case Rev. 2007;12(1):27-35

Al-Mulhim AS, Al-Ghamdi AM, Al-Marzooq HM, Mohammad HA, Gharib IA. The role of fine needle aspiration cytology and imprint cytology in cervical lymphadenopathy. Saudi Med J. 2004;25:862-5.

Pandav AB, Patil PP, Lanjewar DN. Cervical lymphadenopathy – Diagnosis by F.N.A.C., A study of 219 cases:Asian J Med Res. 2012;1(3):79-83.

Kochhar AK, Duggal G, Singh K, Kochhar SK. Spectrum of cytological findings in patients with lymphadenopathy in rural population of southern Haryana, India - experience in a tertiary care hospital. Inte J Patho. 2012;13(2):7-11.

Khajuria R, Goswami KC, Singh K, Dubey VK. Pattern of Lymphadenopathy on Fine Needle Aspiration Cytology in Jammu: J K Science 2006;8:157-9.

Lakhey M, Bhatta CP, Mishra S. Diagnosis of Tubercular Lymphadenopathy by Fine Needle Aspiration Cytology, Acid-Fast Staining and Mantoux Test: J Nepal Med Assoc. 2009;48(175):230-33.

Pandav AB, Patil PP, Lanjewar DN. Cervical lymphadenopathy – Diagnosis by F.N.A.C. A study of 219 cases. Asian J Med Res. 2012;1(3):79-83.

Rajwanshi A, Bhambhani S, Das DK. Fine-needle aspiration cytology diagnosis of tuberculosis. Diagnostic Cytopathology. 1987;3(1):13-6.

Goswami HM, Parikh UR, Barot HP, Vaghela GM, Yadav KS, Vegad MM et al. Efficacy Of Fine Needle Aspiration Cytology, Ziehl-Neelsen (Z-N) Stain And Culture (Bactec) In Diagnosis Of Tuberculosis Lymphadenitis. Int J Microbio Res. 2012;4(7):275-8.

Nidhi P, Sapna T, Shalini M, Gupta K. FNAC In Tuberculous Lymphadenitis: Experience From A Tertiary Level Referral Centre; Indian J Tuberculosis. 2011;58:102-7.

Prasoon D. Acid Fast Bacilli in Fine Needle Aspiration Smears from Tuberculous Lymph nodes-Where to look for them: Acta Cytol. 2000;44:297-300.

Downloads

Published

2016-12-16

How to Cite

Upadhyay, G. P., & Thakker, R. M. (2016). Evaluation of fine needle aspiration cytology as the initial diagnostic test in cases of cervical lymphadenopathy. International Journal of Research in Medical Sciences, 4(12), 5103–5107. https://doi.org/10.18203/2320-6012.ijrms20164066

Issue

Section

Original Research Articles