A comparative study of diagnostic efficacy of fine needle aspiration cytology to open biopsy in cervical lymphadenopathy in a tertiary care hospital, Kanchipuram district, India

Dhinesh Babu K., M. Bhaskar, T. Chitra


Background: Lymphadenopathy is a very common clinical manifestation of many diseases, defined as an abnormality in the size or character of lymph nodes, caused by the invasion or propagation of either inflammatory cells or neoplastic cells into the node. Objectives of this study were to evaluate the diagnostic efficacy of the fine needle aspiration cytology of cervical and axillary lymphadenopathy as compared to open biopsy for histopathological examination. A comparative study of diagnostic efficacy of FNAC cervical and axillary lymphadenopathy as compared to open biopsy for histo-pathological examination was carried out on the patients with cervical and axillary lymph adenopathy coming to OPD in Karapaga Vinayaga Medical College and Hospital, Madhuranthagam.

Methods: All patients selected as per inclusion and exclusion criteria underwent FNAC of lymph node followed by open biopsy of same lymph node.

Results: The results revealed that, the overall diagnostic accuracy was 82.00% with accuracy of 91.70% for tuberculous lymphadenitis and 80.00% for metastatic carcinoma with positive predictive value of 100.00%. In 50.00% of the patients, enlarged tuberculous lymph nodes were matted. Cervical group of lymph nodes were the most commonly affected group of lymph nodes (79.00%). In the present study diagnostic accuracy for metastatic carcinoma was 80.00% and for squamous cell carcinoma was 100.00%. It must be stressed that when the fine needle aspirate appears purulent or when tuberculosis is clinically suspected, specimen should be stained for acid fast bacilli.

Conclusions: It improves diagnostic capability of FNAC. If FNAC is positive surgeon can proceed to treat the neck without excisional biopsy of the enlarged lymph nodes. Supraclavicular lymphadenopathy rarely represents curable disease and these nodes can be excised for histological confirmation. FNAC should be followed by open biopsy if negative. The use of flow cytometry, tumour markers, immunocytochemistry of FNA specimen have excellent potential for cytological based diagnosis.


FNAC (fine needle aspiration cytology)

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Bielamowicz SA, Storper IS, Jabour BA. Spaces and triangles of head and necek. Head Neck. 1994;164:383-8.

Rouviere H. Anatomy of the human lymphatic system. Ann Arbor MI: Edward Bros Inc; 1948.

Fisch V. Lymphography of the cervical lymphatic system. Philadelphia: WB Saunders Co; 1968.

Reede DL, Bergeron RT. The CT evaluation of the normal and diseased neck. Sermin Ultrasound CT MR. 1986;7:181-201.

Shah JP, Strang E, Spiro RH. Neck dissection, current and future possibilities. Clin Bull. 1981;11:25-33.

Robins KT, Medina JE, Wolfe GT. Standardizing neck dissection terminology: official report of the academy’s committee for head and neck surgery and oncology. Arch Otolaryngol Head and Neck Surg. 1991;117:601-5.

Mc. Gregor’s L. Synopsis of Surgical Anatomy. 12th Ed. Bombay: K. M. Varghex Publishing house; 1999.

Pitts WC, Weiss LM. Neoplastic Hematopathology: The role of fine needle aspiration biopsy in diagnosis and management of hematopoietic neoplasms. Baltimore: Williams and Wilkins; 1992.

Silverberg S, Delellis RA, Frable WJ. Principle and practice of surgical pathology and cytopathology: Lymph Nodes and Spleen. 3rd Ed. London: Churchill Livingstone; 1997.

Rappaport H. Tumors of the hematopoietic system, In: Atlas of Tumor Pathology. Section III, Fascicle 8. Armed Forces Institute of Pathology, Washington DC; 1967:241-247.

Strickler JG, Warnke RA, Weiss LM. Necrosis in lymph nodes. Pathol Annu 1987;22(2):253-82.

Cleary KR, Osborne BM, Butler JJ. Lymph node infarction foreshadowing malignant lymphoma. Am J Surg Pathol. 1982;6:435-42.

Cook MG. The size and histological appearance of mesenteric lymph nodes in Crohn’s disease. Gut. 1972;13:970-2.

Bascom R, Johns CJ. The natural history and management of sarcoidosis. Adv Intern Med. 1986;31:213-41.

Hollingsworth HC, Loingo DL, Jaffe ES. Small noncleaved cell lymphoma associated with florid epithelioid granulomatous response: A clinicopathologic study of seven patients. Am J Surg Pathol. 1993;17:51-9.

Sacks EL, Donalsdson SS, Gordon J, Dorfman RF. Epitheloid granulomas associated with Hodgkin’s disease: Clinical correlations in 55 previously untreated patients. Cancer. 1978;41:562-7.

Van den Oord JJ, de Woolf-Peeters C, Facchetti F, Desmer VJ. Cellular composition of hypersensitivity type granulomas. Immunohistochemical analysis of tuberculous and sarcoidal lymphadenitis. Hum Pathol. 1984:559-65.

Reid JD, Wolinsky E. Histopathology of lymphadenitis caused by atypical mycobacteria. Am Rev Respir Dis. 1969;99:8-12.

Lukes RJ, Butler JJ. The pathology and nomenclature of Hodgkin’s disease, Cancer Res. 1996;26:1063-81.

Boring CC, Squies TS, Tong T. Cancer statistics, 1993. CA Cancer J Clin. 1993;43:7-26.

MacMahon B. Epidemiology of Hodgkin’s disease. Cancer Res. 1966:1159-1200.

Weiss LM, Chang KL. The association of the Epstein-Barr virus with hematolymphoid neoplasia. Adv Anat Pathol. 1996;3:1-15.

Weiss LM, Chen YY, Liu XF, Shibata D. Epstein-Barr virus and Hodgkin’s disease: a correlative in situ hybridization and polymerase chain reaction study. Am J Pathol. 1991;139:1259-65.

Kaplan HS. Hodgkin’s Disease. Cambridge MA: Harvard University Press; 1980.

Dass DK, Gupta SK, Datta BM, Sharma SC. Fine needle aspiration cytodiagnosis of Hodgkin’s disease and its subtypes: Scope and limitations. Acta Cytol. 1989;34:329-36.

Devasa SS, Fears T. Non-Hodgkin’s lymphoma time trends: United States and International Data. Cancer Res. 1992;52:5432-40.

Gail MH, Pluda JM, Rabkin CS. Projections of the incidence of non-Hodgkin’s lymphoma related to acquired immunodeficiency syndrome. J Nat Cancer Inst. 1991;83:695-701.

Scherr PA, Hutchison GB, Neiman RS. Non-Hodgkin’s lymphoma and occupational exporsure. Cancer Res. 1992;52:5503-9.

Russell J, Skinner J, Orell S, Seshadri R. Fine needle aspiration cytology in the management of lymphoma. Aust NZJ Med. 1983;13(4):365-8.

Bhaskar M, Babu D. A Comparative study of diagnostic efficacy of fine needle aspiration cytology of cervical and axillary lymphadenopathy as compared to open biopsy for histopathological examination in Karpaga Vinayaga Medical College and Hospital, Madhuranthagam. IOSR-JDMS. 2015;14(4)(III):57-62

Robert NJ, Garnick MB, Frei E. Cancers of unknown origin: current approaches and future perspectives. Semin Oncol. 1983;9:526-31.

Copeland EM, McBride CM. Axillary metastasis from an unknown primary site. Ann Surg. 1973;178:25-7.

Finkbeiner WE, Eghert BM, Groundwater JR, Sagebier RW. Kaposi’s sarcoma in young homosexual men, a histopathologic study with particular reference to lymph node involvement. Arch Pathol Lab Med. 1982;106:261-4.

Chang Y, Cesarman E, Pessin MS. Identification of herpesvirus like DNA sequences in AIDS. Associated Kaposi’s sarcoma. Sci. 1994;26:1865-9.

Gnepp DR. Diagnostic surgical pathology of head and neck: Cyst of the neck, unknown primary tumour and neck dissection. Einband, Gebunden: W. B. Saunders; 2001.

Kline TS. Handbook of fine needle aspiration biopsy. 2nd Ed. New York: Churchill Livingstone; 1998.

Shaha A, Webber C, Marti J. Fine needle aspiration in the diagnosis of cervical lymphadenopathy. Am J Surg. 1986;152:420-3.

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;104:24.