Role of Cytological Evaluation in Cervical Lymphadenopathy

Keshavarajan, G (2013) Role of Cytological Evaluation in Cervical Lymphadenopathy. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: A neck mass in an adult, when present for longer than a week is pathological until proven otherwise. Enlarged lymph nodes are by far the most common neck masses encountered. In our country, tubercular lymphadenitis is not uncommon but even so, a large percentage of all persistent adult neck masses in adults turn out to be malignant. Lymphadenopathy is one of the first sign of malignancy in a patient. FNAC not only confirms the presence of metastatic disease, but also gives clues regarding the nature and origin of the primary tumour. The number of lymph nodes involved, the size of the lymph nodes or the lymph node metastasis, or the regional lymph node basin involved also has been shown to have prognostic value. In patients with enlarged lymph nodes and previously documented malignancy, FNAC can obviate further surgery performed merely to confirm the presence of metastasis. However, regional lymphadenopathy is not always due to metastatic tumour, and not every nodule represents a lymph node. Cysts (congenital or acquired), abscesses, subcutaneous benign and malignant tumours may also raise the question of lymph node metastasis, especially in patients with a known tumour. A positive evidence of tuberculosis can obviate the need for further evaluation and leads to early instillation of definite therapy at the secondary or primary care centre itself. Early treatment leads to better prognosis, as organism load and virulence are minimal; with a good host response. The disease spread and community burden are significantly reduced. Avoiding false-positive diagnosis is of obvious importance since therapeutic and surgical decisions are taken on cytology results. Moreover; the procedure is very simple, cost effective, and free from complications, well tolerated by the patient, can be done on an out-patient basis and repeatable when necessary. India is imminently suited to use this procedure. This study will address the neck nodes occurring in the adult population. They are usually metastatic nodes, lymphomas or tuberculosis. The metastatic are generally from the upper aero digestive tract, thyroid and salivary glands or may present as occult primaries. Occasionally a neck metastasis from a distant site springs from the gastrointestinal tract, kidney or the lung. Other primary sites below the clavicle, which may appear in the neck, are the cervix, ovary, testis and sometimes even the bladder. AIMS AND OBJECTIVES: • To study the pattern of cervical lymph node enlargement. • To evaluate the diagnostic accuracy of FNAC in cervical lymphadenopathy with an emphasis on discordant cases between the cytology and the histopathology. MATERIALS AND METHODS: The study was conducted on 100 selected patients with cervical lymphadenopathy who presented to the General Surgical Department with cervical lymphadenopathy. Patients’ informed written consent was taken. The patients were examined clinically after taking a detailed history. Nodes enlarged were classified according to Memorial Sloan-Kettering Cancer Centre leveling system of cervical lymph nodes. The number of nodes, their size, consistency and presence of periadenitis was noted at each level. Histories of any form of previous treatment to the nodes like radiotherapy, chemotherapy were excluded from the study. Terminally ill patients were also excluded. Blood investigations and radiological investigations were made. Ultrasonography of the neck and CT scan were made wherever necessary. A pre FNAC clinical diagnosis was arrived. Patients requiring surgical biopsy either in the form of node biopsy or neck dissection were included in study. A Fine Needle Aspiration Cytology was done. The equipments used for FNAC; 1. Spirit soaked cotton swab, 2. 10 ml disposable syringe, 3. 22 G disposable needle, 4. 5 Glass slides, 5. Jar with ether-alcohol fixative. RESULTS : A total of 100 patients were examined, subjected to FNAC of cervical lymph nodes and histopathological study. Patients with acute presentation of lymphadenopathy and diagnosed as non-specific lymphadenitis with or without FNAC correlation were excluded from study. They were treated with antibiotics and followed up in the outpatient department. The size of the nodes, which were, sampled range from 1 – 6 cm. No complication due to cytology occurred in the series. All inadequate and inconclusive aspirations were repeated. CONCLUSION: Cervical lymphadenopathy can be due to varying causes. The diagnosis of which involves clinical examination, imaging and pathological correlation. The fact that secondaries from head and neck primary, follows definitive patterns of nodal spread proves very valuable. Cytology forms one of the most important investigations in the initial evaluation of cervical lymphadenopathy. Early confirmation of the disease facilitates institution of immediate treatment. In case of discordance between clinical and cytological findings, FNAC is always repeatable. Further a positive cytology is always significant. A negative result does not rule out the disease and may require further evaluation. A good cytological study requires a good communication between an experienced cytologist and treating surgeon. This study demonstrates that fine needle aspiration is a safe, accurate and valuable tool in the evaluation of cervical lymphadenopathy. It helps in planning surgery for malignant cases, where definitive operative intervention can be performed in one session. It permits early institution of anti-tubercular drugs in patients with tuberculous lymphadenitis. In case of undetected primary tumour, FNAC directs further investigations towards the possible primary. The two fundamental requirements on which the success of cytology depends are representativeness of the sample and high quality of the preparation. The main advantage of FNAC lies in its simplicity. Being an uncomplicated outpatient procedure that offers a rapid and specific diagnosis with little trauma, it is very cost-effective. It is ideal for developing countries and smaller hospitals with limited resources.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Cervical Lymphadenopathy ; Cytological Evaluation.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 26 Mar 2018 13:56
Last Modified: 26 Mar 2018 13:56

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