DIAGNOSTIC UTILITY OF FINE NEEDLE

ASPIRATION CYTOLOGY IN
LYMPHADENOPATHY

Dr.Sravani.P
Post Graduate
Department Of Pathology
S.V.S Medical college
Mahabubnagar.
BACKGROUND:

Aspiration of lymph nodes for diagnostic

purpose was reported early in 1904 by Grieg
and Gray for the diagnosis of trypanosomiasis.

In 1921, Guthrie attempted to correlate

lymph node aspiration cytology with various
disease processes.
 Serves as an excellent clue to the
underlying disease

The cytological features frequently

correlate well with histologic appearance of
the same lesion

Ready identification of metastasis or

recurrence, now considered as a valuable
diagnostic aid and is gaining popularity.
OBJECTIVES

This study was conducted in S.V.S Medical

college and Hospital, Mahabubnagar.

The aim of this study was:

To evaluate the diagnostic efficacy of the

fine needle aspiration cytology of
lymphadenopathy as compared to open biopsy
.
 To study the frequency of neoplastic &
non-neoplastic lesions of the lymph node
& their distribution in different age groups

To study the different cytomorphological

patterns of various lymphadenopathies
MATERIAL AND METHODS

A prospective study was conducted on 400

patients of lymphadenopathy referred to the
Department of Pathology, S.V.S Medical
College, Mahabubnagar, from 2009 to 2011.

FNAC of the enlarged lymphnodes was

performed with informed consent of the
patient; following thorough clinical
examination.
 Palpable nodes were aspirated by using a
23-25 G needle and syringe.

Deeply located ones were aspirated by a

radiologist

In all the cases, alcohol fixed smears were

made and stained with H &E ; and for each
case an additional slide was kept unstained
to stain with ZN stain & special stains as &
when eeded.
 The aspiration smears were studied to
arrive at a probable diagnosis.

In the available cases FNAC diagnosis

was further correlated & compared with
the histological diagnosis,from paraffin
embedded sections(4-5 mm) of tissue
blocks, fixed in 10% formal saline.
RESULTS:

In the present study out of 400 cases of

fine needle aspiration cytology only 85
cases were available for biopsy.

28 (7%) of the cases were non diagnostic

because of inadequate sampling.

There were 308 Non-neoplastic lesions

and 64 Neoplastic lesions.
 Frequency of various Neooplastic & Non neoplastic
lesions :

S.NO. TYPE OF NO. %

LESION
TBLN
1. 183 45.75%

2. CNSL 91 22.75%
NTGL 5.5%
3. 22
ASL 3%
4. 12
5. 11.25%
Metastasis 45

6. 3.8%
Lymphoma 17

7. 0.05 %
Leukemia 02

Total 400 100%

Tuberculous lymphadenopathy was the
most common diagnosis - 45.75% of the
total cases

Majority of the patients (63.75%) were

between 11-40 years age group


Graph 1 Showing sex distribution

215

210 M : F = 1:1.13
205

200
212
195 Series1

190

185 188
180

175
Males Females
 Graph Showing various sites involved in
lymphnode lesions
250
59.75%
200
239
No.of.cases

150

100 69
45
35
50 11 8
0
a l ar y al d s
ic l a r n il se er
v bu i ll ui a t h
er di
A
x
In
g
er O
C an n
e
ubm G
S Site involved
Graph Showing Cytological features of tuberculosis

120
No.of cases of tuerculosis

100 N0.

80

60

40 101
42 40
20

0
Microscopic patterns of tuberculosis assosciated
with AFB positivity
Overall AFB positivity - 31.14% of tuberculous cases

7%
14%

79%

Necrosis only Granulomas with necrosis

Granulomas only
Chronic non specific lymphadenitis
had high number of false positive
cases.

The diagnostic accuracy was 85.71%

for chronic non specific
lymphadenitis.
Metastasis

The Sensitivity , Specificity ,PPV & NPV were

100%,97.4%, 77.8% & 100 % respectively.

Of the 45 cases of metastatic deposits on

FNAC, 24 cases belonged to squamous cell
carcinoma & 21(46.67%) cases had known
primary.
SQUAMOUS CELL
CARCINOMA
SECONDARIES
There were 17 cases of lymphomas

14 were of Hodgkins type and 3 were

Non-Hodgkin’s lymphoma with the
diagnostic accuracy of 100 %.

Mixed cellularity was the predominant

subtype in Hodgkins lymphoma.

In 02 cases of Non hodgkins lymphoma

one was reported as burkitts lymphoma
variants of RS cells
FNAC and Histopathologic results according to the sta.tus
of malignancy.
Sensitivity- 100 %, specificity- 96.97% ,PPV- 90.48% ,NPV - 100 %

HISTOPATHOLOGY
FNAC

BENIGN MALIGNANT TOTAL

BENIGN 64 00 64

MALIGNANT 02 19 21

TOTAL 19 66 85
Showing sensitivity & specificity of FNAC over biopsy in
various lesions

Type of lesion Sensitivity Specificity

TUBERCULOUS GRANULOMATOUS
LYMPHADENITIS 87.2 % 97.8 %
CHRONIC NON-SPECIFIC
LYMPHADENITIS 85.71 % 93.75 %
NON TUBERCULOUS
GRANULOMATOUS LYMPHADENITIS 83.3 % 97.5 %

METASTASIS
100 % 97.4 %

HODGKINS LYMPHOMA
100 % 100 %

NON HODGKINS LYMPHOMA 100 % 100 %

LEUKEMIA 100 % 100 %

 Showing diagnostic co-relations of FNAC
Cytology Histopathology diagnosis
diagnosis
LYMPHOMA

METAST
TBLN CNSL NTGL
ASIS
LEUKEMIA Total
HL NHL

34 00 01 00 00 00 00 35
TBLN

04 18 00 00 00 00 00 22
CNSL
NTGL 01 01 05 00 00 00 00 07
METAS
00 02 00 07 00 00 00 09
TASIS
HL 00 00 00 00 08 00 00 08

NHL 00 00 00 00 00 02 00 02

LEUKEMIA 00 00 00 00 00 00 02 02
 In 76 cases, the FNAC diagnoses were
compatible with histopathology, a total
accuracy of 89.41%.

In nine cases cytological diagnosis was not

in accordance with histopathological
diagnosis.
 Comparision with other studies

Positive N egative No.of

Sensitivity. Specificity. Predictive Predictive Accuracy.
Study (%) (%) Value Value (%) diagnostic
(%) (%)
aspirates

Shamshad
Ahmad et
al (2005) 94.6 98.5 N/A N/A 97.6 115

Naeem
Ahmad et
al(2009) 95.8 100 N/A N/A 93 50

Rakshan
et al(2009) 75.8 96.6 94 85.1 88 151
Our
study 100 96.97 96.97 100 89.41 85
CONCLUSION :

The metastatic carcinomas, and tuberculous

lymphadenopathy can be diagnosed by FNAC
with a high degree of accuracy.

In cases of metastasis of unknown origin FNAC

is useful adjunct to diagnostic procedures and can
point to primary depending upon the cell type.

Early diagnosis of lymphoma by FNA especially

Hodgkin’s disease, may contribute to cure of the
disease .
 Lack of tissue architecture on FNAC can
be overcome by subjecting samples to flow
cytometry, T-cell, B-cell markers and
immunocytochemistry analysis.

Finally we conclude that, FNAC is

simple ,safe, self reliable, cost effective and
less time consuming out patient procedure
which can be used as an initial diagnostic
tool for lymphadenopathies
REFERENCES :

Mohammad Rakhshan, Azadeh Rakhshan .The Diagnostic Accuracy of

Fine Needle Aspiration Cytology in Neck Lymphoid Masses Iranian
Journal of Pathology (2009)4 (4), 147- 150.

Shamshad Ahmad, Shakeel Akhtar , Kafil Akhtar , Shano Naseem ,

Tariq Mansoor .study of fine needle aspiration cytology in
lymphadenopathy with special reference to acid-fast staining in cases of
tuberculosis. JK science 2005;7(1):1-4.

Naeem ahmed,saima israr,Muhammad sajjad ashraf ;comparision of

Fine Needle Aspiration Cytology and excision biopsy in the diagnosis of
cervical lymphadeopathy;pakisthan journal of surgery,volume 25 issue
2 2009:72-75.
THANK YOU