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

Abstract

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.