Introduction to Sydney System
for lymph node cytopathology
Dr Maulika Agarwal
INTRODUCTION
SYDNEY SYSTEM
• Developed in 2019 by International Cytology Congress in Sydney
• Five diagnostic reporting categories:
1. Inadequate/nondiagnostic (L1)
2. Benign (L2)
3. Atypical (cells) undertermined significance/ atypical lymphoid
uncertain significance (AUS/ALUS) (L3)
4. Suspicious (L4)
5. Malignant (L5)
L1: Inadequate/non diagnostic
• Includes cases that cannot be diagnosed properly:
Scant cellularity
Extensive necrosis
Technical limitations
Repeat FNAC, core needle, or excision
biopsy is recommended in these cases
L2:Benign
• Includes cases of:
Suppurative inflammation
Granulomatous inflammation
Reactive lymphoid hyperplasia
L3: Atypical (cells) undetermined significance/ atypical
lymphoid uncertain significance (AUS/ALUS)
• Includes:
Two-cell populations in which the features suggest a reactive process but
follicular lymphoma cannot be excluded
Or
The atypical cells are not lymphoid cells (AUS)
Or
There is a monotonously small cell population for which low grade B-cell
lymphomas cannot be excluded
L4: Suspicious
• Includes cases with :
Monomorphic atypical lymphoid cells that are suspicious of lymphoma but
cytomorphology alone is insufficient to make the diagnosis
Polymorphous lymphoid smears containing a few Reed-Sternberg-like cells
Burkitt lymphomas with scantly cellular cells
Atypical cells suspicious for metastasis are detected but are too scant to be
diagnosed
L5:Malignant
• Includes:
Small to medium sized cells of non-HLs
supported by evidence of clonality
All cases in which cytopathological
features alone are sufficient to identify
large
cell non-HLs
HL with appropriate cellular background
and diagnostic Reed-Sternberg cells
Metastatic neoplasms
THANK YOU…!!!
