Diagnostic accuracy of Thinprep® in cervical lymph node aspiration: Assessment according to the Sydney system

Abstract

Background: Fine-needle aspiration cytology (FNAC) is a reliable technique that has been used for many years in lymphadenopathy diagnosis. Although conventional smear is the standard approach in FNAC, liquid-based cytology (LBC) is accepted as an alternative method. Reporting standardization is a significant gap in fine-needle aspiration cytology, leading to failure in pathologist-clinician dialog and interobserver variability. In 2020, an expert panel proposed the Sydney system for classifying and reporting lymph node aspiration cytology. This study aimed to evaluate the diagnostic accuracy of LBC in lymph node aspiration cytology under the guidance of the Sydney system.Methods: Five hundred-four LBC samples were reevaluated and classified according to the Sydney system. Of these, n = 24 were categorized as L1-inadequate/nondiagnostic, n = 283 as L2-benign, n = 36 as L3-atypical cells of undetermined significance/atypical lymphoid cells of uncertain significance (AUS/ALUS), n = 48 as L4-suspicious, and n = 113 as L5-malignant. Four hundred-one samples were histopathologically confirmed. The diagnostic accuracy of LBC and the risk of malignancy for each Sydney category were calculated. Results:The results were as follows: sensitivity 98.97%; specificity 98.60%; positive predictive value 94.80%; negative predictive value 99.29%; and overall diagnostic accuracy 98.75%. The ROM was 16.6% for L1, 0.7% for L2, 88.8% for L3, and 100% for L4 and L5. Conclusion:LBC is suitable for use in lymph node aspiration under the guidance of the Sydney system and has high diagnostic accuracy. Future comprehensive studies will increase the applicability of the Sydney system and minimize interobserver variability.

The Application of the Proposed Sydney System for Reporting Lymph Node Cytopathology: A Five-Year Experience of an Academic Institution in South India

“…The most frequent interpretation in category L2 was reactive lymphoid hyperplasia followed by granulomatous lymphadenitis (GLN), which is similar to that reported in other studies [5–9]. There was a single case of IgG4-related lymphadenopathy on histopathology, which was rendered a diagnosis of GLN in cytopathology, Figure 1.…”

“…It also provides recommendations for management in each category. There are studies in the literature that had analyzed the utility of this system in routine reporting [5][6][7][8][9][10]. The present study aimed to analyze the diagnostic utility of the proposed Sydney system for reporting lymph node cytopathology, establish the histopathological correlation of each category, and highlight the cytological features of rare and atypical lymphoid lesions.…”

COVID‐19 post‐vaccination lymphadenopathy: A review of the use of fine needle aspiration cytology

“…LN‐FNAC is a useful and effective procedure in the diagnosis of lymphadenopathy 27–30,32–34,80,81 . The COVID‐19 pandemic led to a worldwide reduction in the number of FNAC procedures performed, in general and in lymph nodes specifically.…”

“…LN-FNAC is a useful and effective procedure in the diagnosis of lymp hadenopathy. [27][28][29][30][32][33][34]80,81 The COVID-19 pandemic led to a worldwide reduction in the number of FNAC procedures performed, in general and in lymph nodes specifically. Paradoxically, the pandemic has indirectly enhanced and highlighted the role of LN-FNAC, which was the procedure of choice when more invasive core-needle or surgical biopsies were not available, particularly during the lockdowns, when access to hospitals was extremely restricted, even for therapeutic procedures.…”

“…Numerous studies have reported that lymph node fine needle aspiration cytology (LN-FNAC) is an accurate, safe, effective, and well-tolerated diagnostic procedure, both for reactive processes and for lymphoma and metastases. 5,[27][28][29][30][31][32][33][34] A review of studies on LN-FNAC in C19-LAP is reported herein.…”