Research Article (Open access) |
---|
SSR
Inst. Int. J. Life. Sci., 5(6): 2436-2441,
November 2019
Utility of FNAC
as a Diagnostic Role in Lymphadenopathy Cases of Different Age Groups
Mahendra Singh1,
Jaivijay Tiwari2*
1Prof. & Head, Department of Pathology, GSVM Medical College, Kanpur, India
2Junior Resident III, Department of Pathology, GSVM Medical College,
Kanpur, India
*Address for Correspondence: Dr. Jaivijay
Tiwari, Junior Resident III, Department of Pathology, GSVM Medical College,
Kanpur, U.P, India
E-mail: Jaivijay9415@gmail.com
ABSTRACT- Background: Fine-needle aspiration cytology (FNAC) is a simple
diagnostic tool to diagnose causes of lymphadenopathy. The cytologic patterns
of lymph node fine needle aspirations (FNAs) show signs of a wide variation in
different diseases. In the present study, we study the cytologic patterns of
lymph node sequence of different age groups.
Methods:
The
present study was conducted in the Department of Pathology, GSVM Medical College, Kanpur. The
total number of cases 1681 with lymphadenopathy was taken for this study.
Routine investigations, which included complete blood counts, biochemical
tests, X-Ray chest (PA View), Ultrasound/ CT scan (If indicated). FNAC was done
and the slides were stained with Haematoxylin and Eosin stain, Giemsa stain and
Ziehl-Neelsen stain (if indicated).
Results:
In
the present study, the commonest site of involvement was the cervical lymph
node 1196 (71.15%). Overall benign lesions were 1575 (93.69%) and malignant
lesions 106 (6.31%). In benign lesions, Tubercular lymphadenitis was the most
frequently encountered lesion 934 (55.56%) followed by reactive hyperplasia 310
(18.44%). FNAC is a simple procedure and no hospitalization or anaesthesia is
required.
Conclusion:
FNAC
is a safe, inexpensive repeatable and rapid procedure in which no anaesthesia
is required. FNAC is useful as an outdoor diagnostic procedure because of early
diagnosis in comparison to histopathological diagnosis.
Key-words: Cervical
lymph node, FNAC, Lymphadenopathy, Metastatic, Reactive Hyperplasia,
Tuberculous Lymphadenitis
INTRODUCTION
Lymph
nodes play a major role in the host defense system as not only cleans and filter
lymph but also produce lymphocytes and antibodies. The term lymphadenopathy
refers to lymph nodes, which are abnormal in size, number or firmness [1].
Depending on the locations draining particulars topographic regions, they
are grouped as cervical, axillary, Supra-clavicular, auricular, inguinal,
sub-mental lymph nodes and so on [2].
The
etiology of lymphadenopathy varies from infectious, autoimmune disease,
metabolic disease, malignancies etc. Enlarged lymph nodes are easily
approachable for fine needle aspiration and hence FNAC is a simple and
important diagnostic tool for lymphadenopathy. Lymphadenopathy is most commonly
seen in extra-pulmonary tuberculosis and tuberculous lymphadenitis is the
frequent cause of peripheral lymphadenopathy [3]. Rapid
Strides in the technical advancement of FNAC has made it very easier to
diagnose most of the lesions of lymph nodes has reduced otherwise
time-consuming and invasive open biopsy of lymph nodes. FNAC is a simple
procedure, which is a safe rapid and inexpensive and relatively less invasive
method that could be carried out as an outdoor procedure without anaesthesia
for establishing the diagnosis of pathological lesions occurring in lymph nodes
on the exposed, easily accessible regions of the body [4,5]. This
study was undertaken with the aim of highlighting the pattern of
lymphadenopathy on FNAC.
MATERIAL
AND METHODS
Study duration-
Duration of study was from January 2018 to September 2019. The total number of cases
included 1681 of lymphadenopathy in the Department of Pathology in
collaboration with Department of Medicine, ENT, Paediatrics, Surgery, TB chest
and Oncology, G.S.V.M. Medical College, Kanpur and associated hospital Kanpur,
India.
The
study group includes patients of different age groups suffering from various
diseases attending OPD, referred for the FNAC of enlarged lymph nodes in the
department of pathology. The patient was explained about the procedure and
informed consent was taken. The 20 ml disposable syringe was attached to a 22
gauge needle; the lymph node was palpated, localized and fixed between two
fingers. The overlying skin was swabbed by rectified spirit. The needle was
inserted into the palpable lymph node. A vacuum was created by withdrawing
piston of the syringe. The vacuum was maintained while repeated runs in
different directions in the palpable lymph node. The needle along with syringe
was withdrawn together. The aspirated material was squirted onto the clean
glass slides and smears were prepared by pulling apart two slides. Slide was
fixed in fixative containing 95% alcohol and diethyl ether and stained with two
methods viz. Haematoxylin and Eosin stain and Giemsa stain. If
necessary, then Smear was also stained by ZN stain.
RESULTS
In
the present study, FNAC was performed on 1681 patients. Table 1 show that 751
patients were male and 930 patients were female. The proportion of male to
female patient was 1: 1.24. The maximum numbers of cases were detected in the
age range of 1120 years (28.37%), followed by the age group 2130 years
(24.98%). The total number of lymphadenopathy cases detected in the age range
of 010 years was 19.69%
Table
1: Distribution
of cases according to age group and sex incidence
Age
Group (years) |
Sex |
Percentage
(%) |
|
Male
|
Female |
||
0-10 |
200 |
131 |
19.69 |
11-20 |
198 |
279 |
28.37 |
21-30 |
114 |
306 |
24.98 |
31-40 |
77 |
106 |
10.89 |
41-50 |
67 |
57 |
7.38 |
51-60 |
51 |
38 |
5.29 |
61-70 |
37 |
10 |
2.80 |
71-80 |
7 |
2 |
0.54 |
81-90 |
0 |
1 |
0.06 |
Total |
751 |
930 |
100 |
In
this study, most common site was cervical lymph node (71.15%), followed by
sub-mandibular (7.73%), and axillary (5.77%) lymph node. In cervical lymph nodes,
most of the cases had posterior cervical lymphadenopathy (65.8%) followed by
upper anterior cervical lymphadenopathy (5.35%) (Table 2).
Table
2: Anatomical Distribution of Enlarged Lymph Nodes
Site |
Total |
Percentage
(%) |
Cervical lymph node |
1196 |
71.15 |
Sub-mandibular |
130 |
7.73 |
Axillary |
97 |
5.77 |
Supra-clavicular |
97 |
5.77 |
Inguinal |
67 |
3.99 |
Sub-mental |
61 |
3.63 |
Auricular |
31 |
1.84 |
Mesenteric |
1 |
0.06 |
Pelvic |
1 |
0.06 |
Total |
1681 |
100 |
In
this study, 751 patients were male and 930 patients were female. Reactive
hyperplasia of lymph node more commonly affect male 178 cases (57.42%) as
compared to female 132 cases (42.58%) male to female ratio was 1.35: 1.
Tubercular cases more commonly affect female 425 cases (65.89%) as compared to
male 220 cases (34.11%). Male to female ratio was 1: 1.93 (Table 3).
Table 3: Gender wise distribution of
patients according to cytological diagnosis
FNAC Diagnosis |
Sex |
Total |
|
Male |
Female |
||
RHLN |
178 |
132 |
310 |
CL |
78 |
94 |
172 |
TB Abscess |
97 |
156 |
253 |
TBLN with Extensive caseation |
22 |
48 |
70 |
TB LN |
101 |
221 |
322 |
CGL |
54 |
53 |
107 |
CGL with strong possibility of TB |
81 |
158 |
239 |
Necrotizing Lymphadenitis |
4 |
5 |
9 |
Necrotizing Lymphadenitis with strong possibility
of TB |
22 |
28 |
50 |
Organized Abscess |
12 |
7 |
19 |
RHLN with sinus histocytosis |
5 |
2 |
7 |
Metastatic carcinoma |
80 |
19 |
99 |
Atypical hyperplasia of LN |
17 |
7 |
24 |
Total |
751 |
930 |
1681 |
L= Chroinic
lymphadenitis, CGL= Chronic granulomatous lymphadenitis, TBLN= Tubercular
lymphadenitis, RHLN= Reactive Hyperplasia of lymph node
Table 4: Age-wise distribution of
patients according to cytological diagnosis
Age group (Years) |
|||||||||
FNAC Diagnosis |
0-10 |
11-20 |
21-30 |
31-40 |
41-50 |
51-60 |
61-70 |
71-80 |
81-90 |
RHLN (with
sinus histiocytosis) |
161 |
97 |
34 |
11 |
7 |
4 |
2 |
1 |
0 |
CL |
59 |
48 |
35 |
9 |
13 |
6 |
1 |
1 |
0 |
TB Abscess |
30 |
59 |
88 |
38 |
21 |
13 |
2 |
2 |
0 |
TB LN |
25 |
105 |
108 |
50 |
24 |
8 |
1 |
0 |
1 |
TBLN with
Extensive caseation |
5 |
27 |
24 |
10 |
3 |
0 |
1 |
0 |
0 |
CGL |
13 |
45 |
30 |
10 |
3 |
4 |
2 |
0 |
0 |
CGL with
strong Possibility of TB |
21 |
75 |
77 |
29 |
19 |
9 |
9 |
0 |
0 |
Necrotizing
Lymphadenitis |
3 |
0 |
2 |
0 |
3 |
0 |
1 |
0 |
0 |
Necrotizing
Lymphadenitis with Strong Possibility of
TB |
3 |
15 |
13 |
9 |
4 |
4 |
2 |
0 |
0 |
Atypical
hyperplasia of LN |
8 |
4 |
3 |
2 |
3 |
3 |
1 |
0 |
0 |
Organized Abscess |
3 |
2 |
3 |
3 |
3 |
2 |
2 |
1 |
0 |
Metastatic
carcinoma |
0 |
0 |
3 |
12 |
21 |
36 |
23 |
4 |
0 |
Total |
331 |
477 |
420 |
183 |
124 |
89 |
47 |
9 |
1 |
CL= Chroinic
lymphadenitis, CGL= Chronic granulomatous lymphadenitis, TBLN= Tubercular lymphadenitis,
RHLN= Reactive Hyperplasia of lymph node
Table
4 shows the reactive hyperplasia of lymph node more commonly seen in the age
range of 010 yrs accounting to 50.79% of cases, followed by 1120 yrs age
range of accounting to 30.60% cases. Tubercular cases most commonly detected in
the age range of 2130 accounting to 220 (34.11%) cases followed by in the age
range of 1120 yrs accounting to 191 (29.61%) cases. Out of 99 cases of
metastatic carcinoma, 36 cases (36.36%) was in the age range of 5160 yrs,
followed by 23 cases (23.23%) of age range of 6170 yrs, followed by 23 cases
(23.23%) age range of 6170 yrs and 21 cases (21.21%) age range of 4150
yrs.
Out
of 1681 cases of lymphadenopathy, 1575 cases (93.69%) of benign pathology and
106 cases (6.31%) of malignant pathology found. In out of 1575 benign cases,
664 cases (42.16%) were of male and 911 cases were (57.84%) of female and male
to female proportion was 1: 1.37.
Out
of 106 cases (6.36%) malignant cases, 87 cases (82.08%) were of male and 19
cases (17.92%) were of female. Male to female proportion was 4.58: 1 (Table 5).
Table 5: Distribution
of benign and malignant cases according to sex
Nature of Lesion |
Percentage (%) |
Male (%) |
Female (%) |
Ratio (M: F) |
Benign |
93.69 |
664(42.16) |
911(57.84) |
1: 1.37 |
Malignant |
6.31 |
87(82.08) |
19(17.92) |
4.58: 1 |
Total |
|
751 |
930 |
|
DISCUSSION
Enlarged lymph nodes are accessible for
FNAC to diagnose primary or secondary malignancies and benign lesion. Cases of
lymphadenopathy are most commonly seen in 1120 yrs age group and its range was
28.37%. This finding was correlated by Agarwal et al. [6] and also correlation with study
given by Arun et al. [7] Nirmal et al. [8] and Patro et al. [9]. Proportion of
male to female patients in our observation was found to be 1: 1.24. This
finding is correlated to past study that given by Nirmal et al. [8]; Patro et
al. [9]; and Mane et al.
[10]. Our study correlate lymphadenopathy was seen in most commonly in
cervical region (71.15%) and other similar studies lymphadenopathy most
commonly seen in neck region i.e. 93.73% [11] and 72.5% cases of
cervical in which FNAC were performed given by Ikram et al. [12]. Cervical lymph node was the most frequently
affected group of lymph nodes accounting to 74.24% similar observations also
given by Patro et al. [9];
Farooq et al. [13] and Nur
et al. [14].
In the present study, 93.69% of cases
were of inflammatory lesion of the lymph node. Out of inflammatory lesions, the
most common lesion was tubercular lymphadenopathy accounting to 55.5% cases,
reactive hyperplasia of lymph node accounts for 18.86% cases. Most common causes
of lymphadenopathy was found to be tuberculous lymphadenitis with 32.12% cases
given by Patro et al. [9].
Florence et al. [15]
stated that 35.9% case tubercular lymphadenitis was found, which is most
frequent then other cases. In our study metastasis is most commonly seen in
cervical lymph node, which is similar to results of other studies given by
Nirmal et al. [8] and
Florence et al. [15].
In our study, males
were most commonly affected by reactive hyperplasia of lymph node; proportion
of male to female was 1.35: 1. Whereas, females are most commonly affected by
tubercular lymphadenopathy; proportion of male to female was 1: 1.93. Our study
was shown similar result by some previous published studies by Farooq et al. [13]; Nur et al. [14]; Badge et al. [16] and Bhatta et al. [17]. In our study,
tubercular lymphadenopathy cases are most commonly seen in the age range of
2130 years accounting 34.11% followed by the age range of 1120 years accounting
to 29.61%, cases. Correlate to the past studies that observed by some previous
studies, given by Agarwal et al. [8];
Nur et al. [14]; Badge et al. [16] and Mainali et al. [18].
In
our study metastatic carcinoma was most commonly seen in the age group i.e.
5160 yrs (36.36%) followed by 6170 yrs age range (23.23%). Khajuria et al. [5] found that after 4th
decades overall percentage of metastatic carcinoma was 88%. Agarwal et al. [6]; Mane et al. [10] and Nikethan et al. [19] stated that
metastasis was seen in the middle and elderly age group. In our observations, 16.27% of cases of
tubercular lymphadenitis were AFB positive on Z-N staining but Badge et al. [16] stated that AFB
positive in 28.47% cases of tubercular lymphadenitis with closed result.
Overall AFB positive 32.4% cases in tubercular lymphadenitis observed by Bhatta
et al. [17].
CONCLUSIONS-
Our
study showcased, the usefulness of FNAC in reaching a prompt diagnosis in
patients presenting with lymphadenopathy and also put light on etiology and
pattern of lymphadenopathy. FNAC is a safe inexpensive rapid procedure in which
no anaesthesia required. FNAC is useful as an outdoor diagnostic procedure
because of early diagnosis in comparison to histopathological diagnosis.
Fine Needle Aspiration Cytology finding should be
correlate with the histopathological finding.
ACKNOWLEDGEMENTS- All authors
are very thankful to the Department of Pathology, G. S. V. M. Medical College
Kanpur, India for help in writing the paper.
CONTRIBUTION OF AUTHORS
Research concept- Prof.
Mahendra Singh, Dr. Jaivijay Tiwari
Research
design- Dr. Jaivijay Tiwari
Supervision- Prof.
Mahendra Singh
Materials- Dr. Jaivijay Tiwari
Data
collection- Dr. Jaivijay Tiwari
Data analysis and
Interpretation- Prof. Mahendra Singh, Dr. Jaivijay
Tiwari
Literature search- Dr. Jaivijay Tiwari
Writing article- Dr. Jaivijay Tiwari
Critical review- Prof. Mahendra Singh
Article
editing- Dr. Jaivijay Tiwari
Final approval- Prof.
Mahendra Singh
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