The role of fine needle aspiration cytology (FNAC) in the investigation of superficial lymphadenopathy; uses and limitations of the technique.
Aspirates (n = 163) from 157 patients with enlarged superficial lymph nodes were obtained over a 5-year period in a combined surgical/FNAC clinic. A definitive diagnosis was achieved in over 77% of the cases: benign 52.7%, malignant 25.1%. The diagnostic accuracy was 94.4%, sensitivity 85.4%, and specificity 100%. The false-negative rate was 12.5% but decreased to 3.5% when lymphoma cases were excluded. There were 36 cases of metastatic disease, the majority of which were from a primary breast carcinoma. The main diagnostic difficulty was in distinguishing low-grade lymphoma from reactive hyperplasia. An added advantage was that aspirated material could be used in ancillary tests to help with the differential diagnosis. FNAC has a well-defined role in the investigation of superficial lymphadenopathy. Used in the proper setting it will provide a definitive diagnosis in the majority of cases, especially relating to recurrent malignancy or metastatic disease. Patients with a reactive cytological picture and no clinically suspicious symptoms could be spared unnecessary surgery and reviewed through follow up. This technique is cost-effective, of high diagnostic accuracy, and results in considerable resource savings.
Lioe
T F
TF
Department of Cyto/Histopathology, Belfast City Hospital Trust, Belfast, UK.
Elliott
H
H
Allen
D C
DC
Spence
R A
RA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001707:Biopsy, Needle / Q000379:methods*; D001943:Breast Neoplasms / Q000473:pathology; D002277:Carcinoma / Q000473:pathology* / Q000556:secondary*; D003937:Diagnosis, Differential; D005260:Female; D005833:Genital Neoplasms, Female / Q000473:pathology; D005834:Genital Neoplasms, Male / Q000473:pathology; D006801:Humans; D006965:Hyperplasia; D007866:Leg; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008223:Lymphoma / Q000473:pathology*; D008297:Male; D008545:Melanoma / Q000556:secondary; D008875:Middle Aged; D009333:Neck; D009382:Neoplasms, Unknown Primary / Q000473:pathology; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity