Diagnostic value of lymph node fine-needle aspiration cytology

Diagnostic Accuracy of Fine-Needle Aspiration Cytology in Cervical Lymphadenopathies at a Tertiary Care Center in the Kingdom of Bahrain

Introduction  Fine-needle aspiration cytology (FNAC) has become widely used as a first-line diagnostic tool in the evaluation of cervical lymphadenopathies (LADs). However, there are conflicting reports regarding its accuracy in differentiating between malignant and benign pathologies. In this study, we aim to determine the reliability of FNAC in distinguishing between benign and malignant pathologies causing cervical LAD. Methods This is a cross-sectional study reviewing the electronic medical records of all patients who underwent both FNAC and excisional biopsy of cervical LADs between January 2016 and December 2023 at a tertiary care center in the Kingdom of Bahrain. A comparison was conducted between the cytopathological results obtained by FNAC and the histopathological results obtained by excisional biopsy to determine the diagnostic accuracy of FNAC. Results In the study period, 83 patient records were reviewed and included in the data analysis. Fine-needle aspiration cytology yielded a sensitivity of 89.3%, a specificity of 55.6%, a positive predictive value (PPV) of 72.4%, a negative predictive value (NPV) of 80.0%, and an overall accuracy of 74.7% in diagnosing cervical LADs. Conclusion Despite FNAC being accessible, convenient, and cost-effective, it has certain limitations that can restrict its accuracy in diagnosing lymphomas. We recommend further studies to research these limitations and the possible tools, such as ancillary testing, that may be useful in overcoming them.

Exploring the Spectrum of Lymphadenopathy: Insights From a Three-Year Fine Needle Aspiration Cytology Study in a Tertiary Care Center

Introduction Lymphadenopathy, characterized by the enlargement of lymph nodes, is a common concern encountered by physicians in outpatient settings. It is deemed significant and warrants evaluation due to the diverse range of potential causes, ranging from treatable infections to incurable metastatic malignancies. Fine needle aspiration cytology (FNAC) emerges as a crucial tool in addressing these concerns, acknowledged for its rapid diagnostic capabilities, simplicity, accuracy, and minimal invasiveness. Objectives This retrospective study aims to characterize the spectrum of lymphadenopathy cases observed in a tertiary care center over a specified period, shedding light on the prevalence, etiology, and clinical outcomes associated with this condition. Methods Electronic medical records of patients presenting with lymphadenopathy to the tertiary care center between May 2021 and June 2023 were reviewed. Data on patient demographics, clinical presentation, imaging findings, and cytopathological and histopathological diagnoses were analyzed. Results A total of 300 cases of lymphadenopathy were identified during the study period. The study population exhibited a diverse range of age groups, with a slight predilection for the age range of 11-20 years. The most common sites of lymphadenopathy were in the cervical group, and the predominant clinical presentations included tender lymph nodes and fever. Etiologically, infectious causes, such as accounted for the majority of cases, followed by inflammatory and neoplastic etiologies. Notably, 2.6 % of cases presented with non-specific lymphadenopathy, warranting further investigation. Diagnostic modalities, including imaging studies and histopathological examinations, played a crucial role in establishing accurate diagnoses. The study also highlights the challenges in differentiating benign from malignant lymphadenopathy, emphasizing the need for a comprehensive diagnostic approach. Conclusion This study provides a comprehensive overview of the lymphadenopathy spectrum in a tertiary care center, emphasizing the importance of a multidisciplinary approach for accurate diagnosis and management. The findings contribute to our understanding of the epidemiology and etiological patterns of lymphadenopathy, guiding clinicians in optimizing patient care and outcomes in a tertiary healthcare setting.

Cell block preparation as an adjunctive tool after fine-needle aspiration cytology for screening oral and maxillofacial diseases

OBJECTIVE

To describe the use of cell block (CB) preparation from fine-needle aspiration cytology for diagnosing oral and maxillofacial diseases.

STUDY DESIGN

We performed a retrospective analysis of 568 samples collected by our laboratory for CB preparation from fine-needle aspiration cytology of the oral and maxillofacial region between January 2001 and October 2021. We performed cytologic diagnoses and compared them with the available histopathologic diagnoses to calculate the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CB preparation for identifying malignant lesions.

RESULTS

The most frequent diagnosis was pleomorphic adenoma (n = 44, 7.7%), followed by metastatic squamous-cell carcinoma (n = 28, 4.9%) and odontogenic keratocyst (n = 26, 4.6%). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CB preparation, which revealed detailed morphologic and architectural patterns, were 70.0%, 100.0%, 100.0%, 62.5%, and 80.0%, respectively.

CONCLUSIONS

Cell block preparation from fine-needle aspiration cytology of the oral and maxillofacial region may be a useful adjunctive diagnostic tool for diagnosing oral and maxillofacial diseases because it reveals morphologic and architectural patterns similar to those shown on histopathologic slides, leading to the better categorization of diseases.

Diagnostic Accuracy of Lymph Nodes Fine Needle Aspiration Biopsy Based on The Sydney System for Reporting Lymph Node Cytology

OBJECTIVE

To evaluate the diagnostic accuracy and malignancy risk of The Sydney System Reporting for Lymph Nodes Cytology.

MATERIAL AND METHODS

This study utilized secondary data from 156 cases to conduct a retrospective analysis of a diagnostic test method. During 2019-2021, data were collected at Dr. Wahidin Sudirohusodo's Anatomical Pathology Laboratory in Makassar, Indonesia. The cytology slides of each case were split into five diagnostic groups using the Sydney method, which were then compared with the results of the histopathological diagnosis.

RESULTS

There were six cases in the L1 category, thirty-two cases in the L2 category, thirteen patients in the L3 category, seventeen cases in the L4 category, and ninety-one cases in the L5 class. The malignant probability (MP) is computed for each diagnostic classification. L1 MP value is 66.7%, L2 MP value is 15.6%, L3 MP value is 76.9%, L4 MP value is 94.0%, and L5 MP value is 98.9%. The diagnostic value of the FNAB examination is as follows: 89.9% sensitivity, 92.9% specificity, 98.2% positive predictive value, 68.4% negative predictive value, and 90.47% diagnostic accuracy.

CONCLUSION

The FNAB examination provides high sensitivity, specificity, and accuracy in diagnosing lymph node tumors. Using a classification based on the Sydney system promotes communication between laboratories and clinicians.
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Utility and Limitations of Fine-Needle Aspiration Cytology in the Diagnosis of Lymphadenopathy

BACKGROUND

Fine needle aspiration cytology (FNAC) is a valuable tool for evaluating lymphadenopathy. The purpose of this study was to assess the reliability and effectiveness of FNAC in the diagnosis of lymphadenopathy.

METHODS

Cytological characteristics were evaluated in 432 patients who underwent lymph node FNAC and follow-up biopsy at the Korea Cancer Center Hospital from January 2015 to December 2019.

RESULTS

Fifteen (3.5%) of the four hundred and thirty-two patients were diagnosed as inadequate by FNAC, with five (33.3%) of these diagnosed as metastatic carcinoma on histological examination. Of the 432 patients, 155 (35.9%) were diagnosed as benign by FNAC, with seven (4.5%) of these diagnosed histologically as metastatic carcinoma. A review of the FNAC slides, however, showed no evidence of cancer cells, suggesting that the negative results may have been due to FNAC sampling errors. An additional five samples regarded as benign on FNAC were diagnosed as non-Hodgkin lymphoma (NHL) by histological examination. Of the 432 patients, 223 (51.6%) were cytologically diagnosed as malignant, with 20 (9.0%) of these diagnosed as tissue insufficient for diagnosis (TIFD) or benign on histological examination. A review of the FNAC slides of these 20 patients, however, showed that 17 (85.0%) were positive for malignant cells. The sensitivity, specificity, positive predictive value (PPV), negative predictive values (NPV), and accuracy of FNAC were 97.8%, 97.5%, 98.7%, 96.0%, and 97.7%, respectively.

CONCLUSIONS

Preoperative FNAC was safe, practical, and effective in the early diagnosis of lymphadenopathy. This method, however, had limitations in some diagnoses, suggesting that additional attempts may be required according to the clinical situation.

Ultrasonographic and cytological characterization of ultrasound-guided fine-needle aspiration cytology of cervical lymph nodes for false-negative and false-positive diagnosis

OBJECTIVES

The primary goal of this study was to examine the ultrasound and cytological characteristics of inconsistent cases (false negatives and false positives)of ultrasound-guided fine-needle aspiration cytology (US-FNAC) of cervical lymph nodes, to investigate factors influencing the diagnostic accuracy of fine-needle aspiration, and to improve diagnostic efficiency.

METHODS

The results of US and FNAC of cervical lymph nodes in 562 cases treated at our institution from February 2019 to June 2021 were retrospectively analyzed. FNAC cytology results were compared with the final diagnostic results (242 surgical resections/core-needle biopsy, 320 cases followed up for more than 1 year), and the final diagnostic results were taken as the gold standard, and the ultrasound features and clinicopathology-related features were systematically retrospectively analyzed in cases of inconsistency.

RESULTS

The overall diagnostic accuracy of US-FNAC for cervical lymph nodes was 94.9%, with a false-negative rate of 6.7% and a false-positive rate of 3.8%. Analyzing the cases, sampling error due to factors associated with ultrasound features, such as larger, more numerous nodes, non-solid, hypoechoic, inhomogeneous, and increased vascularity are the main causes of false-negative diagnosis, while smaller nodules, overlapping cytologic patterns, and overinterpretation by pathologists are associated with false-positive FNAC results.

CONCLUSIONS

Proper interpretation of cytomorphologic and ultrasound features can improve diagnostic accuracy, and diagnostic misdiagnosis should be carefully observed, the identification of both features should be enhanced to reduce interpretation errors and sampling errors and to reduce the rate of misdiagnosis and missed diagnoses in fine needle aspiration of lymph nodes.

The use of diagnostic patterns for interventional cytopathology during rapid on-site evaluation and final classification

Pathologist-performed fine-needle aspiration, or interventional cytopathology, is a minimally invasive, highly accurate technique for sampling and diagnosing palpable lesions. Utilizing cytomorphologic patterns during rapid onsite evaluation (ROSE) and final classification is one of many strategies that an interventional cytopathologist can employ to simplify the diagnostic approach. Herein, we provide an overview of the salient cytomorphologic patterns encountered in common specimens obtained by the interventional cytopathologist, including major salivary glands, the thyroid gland, and superficial lymph nodes. The topics covered should provide a primer for those interested in utilizing a site-specific, pattern-based approach to cytopathologic evaluation. In summary, cytomorphologic patterns can be used during ROSE to establish adequacy, build a differential diagnosis, and to appropriately triage the specimen for additional investigation, such as microbiology cultures, a liquid-based preparation, a cell block preparation, flow cytometry, chemical analysis, or molecular diagnostic tests. Finally, this approach can be applied at the time of diagnosis to suggest additional ancillary studies, such as immunohistochemistry, and to inform accurate and definitive classification.