Effectiveness of Fine Needle Aspiration Cytology (FNAC) as an Earlier Key Diagnostic Tool for Cervical Lymphadenopathy

This chapter evaluate the effectiveness and diagnostic accuracy of fine needle aspiration cytology (FNAC) of cervical lymph nodes with an emphasis on discordant cases between the cytology and the histopathology. FNAC can be a reliable triage tool for the surgeon. This is particularly suitable in setting where patients are poor, the doctor has a long operation waiting list to make tissue diagnosis, runs short of time, operating space and facilities and is generally overworked.

The present study was a retrospective one, conducted at the Department of Pathology, Rajshahi Medical College & Hospital located in West-Northern region of Bangladesh over a period of one year (January 2019 to December 2019). FNAC assessed and histopathologically correlated 122 documented cases were included in the study.

The cytological diagnoses were detected to be benign in 107 cases (87.70%) and malignant in 15 cases (12.30%). Reactive lymphadenitis (67.20%) was the most common benign lesion followed by granulomatous lymphadenitis (16.40%). FNAC can strongly suggest a preliminary diagnosis, which can be followed up by biopsy for histopathology and if necessary, immunohistochemistry for confirmation and final classification. The overall diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of cytological diagnosis of cervical lymph node were 97.16%, 75%, 96.26%, and 80%, respectively. The overall diagnostic accuracy was 94.26% while the overall discordance rate was 5.73%.

FNAC can assess correctly metastatic lesions. FNAC is useful adjunct to diagnostic procedures and can point to primary depending upon the cell type.