Image-guided fine-needle aspiration cytology of deep-seated enlarged lymph nodes

Abstract

Purpose: To evaluate the role of image-guided fine-needle aspiration cytology (FNAC) of deep-seated lymph nodes. Material and Methods: Image-guided FNACs were performed on 242 patients of deep-seated lymph nodes which included thoracic, retroperitoneal and abdominal nodes. A sterile 3.5/5-MHz micro convex sector probe was used for localisation of the node. The FNAC was performed using a 0.7- to 0.9-mm needle with the stylet removed and attached to a 20-ml syringe and FNAC handle after the needle was visualised in the lesion. For each case a minimum of 4-5 smears were made, and two observers without bias interpreted the smears. Results: A total of 242 patients were aspirated, of which 216 (90%) aspirations were US-guided and the remaining 26 (10%) were CT-guided. Adequate material for cytologic diagnosis was obtained in 208 (86%) patients with a similar diagnostic accuracy. The aspirate material was non-representative or scanty in 34 (14%) patients. The most common cytological diagnosis was tuberculosis/consistent with tuberculosis seen in 108 (45%) patients followed by metastasis (17%) and reactive hyperplasia (10%). Non-Hodgkin lymphoma was diagnosed in 22 (9%) patients. All patients were briefly followed for a period of 1 1/2 to 2 years (mean 1 year). Conclusion: Image-guided FNAC has a pivotal role, and is a cost-effective tool for establishing tissue diagnosis as a primary investigative modality. It is also helpful and accurate in follow-up of patients with a known malignant disease, thereby avoiding surgical intervention.

Fine-Needle Aspiration Cytology of Retroperitoneal Lesions: A 5-Year Experience with an Emphasis on Cytohistological Discrepancy

“…Nahar Saikia et al [15] reported tuberculosis to be the most common non-neoplastic lesion during the aspiration of deep-seated lymph nodes under guidance. Ahmad et al [7] and Mehar et al [2] documented Koch's lesion in 7 out of 20 retroperitoneal lymph node aspirates and in 8 out of 55 retroperitoneal and spinal lesions, respectively.…”

EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part II

“…A baseline PET examination should be carried out according to the recommendations for staging and response assessment [211]. Pathological analysis of the disease process is of paramount importance and is the reference standard for diagnosis [212]. In patients who have known lymphoma, other important management considerations, such as staging, response to therapy, malignant transformation, and identification of recurrent disease, are also important and biopsy plays a crucial role [211].…”

“…Fine needle aspiration with adjuvant flow cytometry for diagnosing and sub-typing malignant lymphomas has been reported [212] but CNB provides additional diagnostic and prognostic information that may not be easily derived from FNA [224]. Core needle biopsy yields large cores for histological analysis, samples various parts of the node and therefore allows for a WHO classification of lymphoma [225] with additional tests, e. g. immunohistochemistry and receptor analysis.…”

EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part II

“…Chest X-ray and CECT imaging of the neck, chest and abdomen are mandatory to evaluate the stage of the disease. Pathological analysis of the disease process is of paramount importance and is the reference standard for diagnosis [139].…”