Utility and Limitations of Fine-Needle Aspiration Cytology in the Diagnosis of Lymphadenopathy

Abstract

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.

Fine Needle Aspiration Cytology of Lymph Nodes in Metastatic Cancer and Lymphoma: Our Single-institution Experience

“…In the paper by Hwa Jeong Ha et al, FNAC was found to have a sensitivity of 97.8%, specificity of 97.5%, PPV of 98.7% and NPV of 97.7% compared to histopathological analysis. The overall accuracy was 97.7% ( 10 ). For metastatic carcinoma, our results were in good agreement with the cytological diagnosis rate in the literature for metastatic carcinoma in lymph nodes, which was 90 to 100% ( 11 , 12 ).…”

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

“…Ha et al initially introduced the technique of FNAC. FNAC has become widely used as a diagnostic tool for rapid evaluation of mainly superficial lesions [ 8 ]. Lymphadenopathy refers to lymph nodes exhibiting abnormalities in size, consistency, or number.…”

The Diagnostic Value of Fine-Needle Aspiration Cytology in Cervical Lymphadenopathy in Correlation to Postoperative Histopathological Results in a Tertiary Care Center in Saudi Arabia

“…Diagnosed cases were reactive lymph node at 13 (25.0%), TB at four (7.7%), lymphoma at 16 (30.8%), and malignancy at four (7.7%). Another previous study reported that tru-cut biopsy had a sensitivity of 68.42%, a specificity of 83.33%, a PPV of 92.86%, an NPV of 45.45%, and an accuracy rate of 72% [ 4 ].…”

“…A thorough history and physical examination should be implemented in diagnosing CLA; however, clinical assessment alone is not enough because the patient’s presentation can mimic other conditions [ 4 ]. Fine-needle aspiration cytology (FNAC) is the initial step in diagnosing lymphadenopathy due to its simplicity, rapid availability of results, and minimal complications [ 5 ].…”