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Microbiology Research Article

www.medresearch.in 2020 Volume 6 Number 7 September-October
Population

A study on evaluation of the role of ne-needle aspiration cytology in

the etiology of lymphadenopathy in the rural population attending
tertiary care hospital
Sitalata C.1, Kalyan K.2*
DOI: https://doi.org/10.17511/jopm.2020.i07.02
1
Sitalata C., Associate Professor, Department of Pathology, Maharaja Institute of Medical Sciences, Vizianagaram, Andhra Pradesh, India.
2*
Kalyan K., Professor, Department of Pathology, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation,
Gannavaram, Andhra Pradesh, India.

Introduction: Lymph nodes are a site for organized collections of lymphoreticular tissue and are
pink-gray bean-shaped encapsulated organs. Lymph nodes are among the commonly aspirated
organs for diagnostic purposes. Lymphadenopathy is of great clinical significance as underlying
diseases may range from a treatable infectious etiology to malignant neoplasms Fine needle
aspiration cytology (FNAC) is a reliable as well as an inexpensive method used to diagnose
lymphadenopathy of various sites. Aims: To evaluate the usefulness of FNAC as a diagnostic tool in
the etiological causes of lymphadenopathy and to study the cytomorphological features associated
with various lymphadenopathies. Materials and Methods: The present prospective study was
carried out in the Department of Pathology at Maharajah's Institute of Medical Sciences,
Vizianagaram, a Tertiary Care Centre. A total of 210 patients of all age groups underwent FNAC of
enlarged lymph nodes during this study period. Results: FNAC diagnosis was found to be as follows:
tubercular lymphadenitis in 98 cases (46.67%) followed by reactive hyperplasia in 35 cases
(16.67%), metastatic carcinoma 29 (13.8%), granulomatous lymphadenitis 27 (12.85%), non-
specific lymphadenitis 8 (3.8%), acute suppurative lymphadenitis 7 (3.33%) and lymphoma 4 (1.8).
Conclusion: FNAC of lymph nodes is an excellent first-line investigation to determine the nature of
the lesion. It is quick, safe, minimally invasive, and reliable and is readily accepted by the patient.

Keywords: Fine needle aspiration cytology (FNAC), Lymph node, Lymphadenopathy, Tuberculous
lymphadenitis, Malignant neoplasms

Corresponding Author How to Cite this Article To Browse

Kalyan K., Professor, Department of Pathology, Dr. Sitalata C, Kalyan K. A study on evaluation of the

Pinnamaneni Siddhartha Institute of Medical Sciences role of fine-needle aspiration cytology in the etiology
and Research Foundation, Gannavaram, Andhra of lymphadenopathy in the rural population attending

Pradesh, India. tertiary care hospital. Trop J Pathol Microbiol.

Email: 2020;6(7):425-429.

Available From

https://pathology.medresearch.in/index.php/jopm/ar
ticle/view/483

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted

2020-09-24 2020-10-04 2020-10-12 2020-10-20

Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note

No Nil Yes 6%

© 2020 by Sitalata C., Kalyan K. and Published by Siddharth Health Research and Social Welfare Society. This is an Open
Access article licensed under a Creative Commons Attribution 4.0 International License
https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

Tropical Journal of Pathology and Microbiology 2020;6(7) 425

 Sitalata C. et al: A study on evaluation of the role of fine-needle

Drawbacks of FNAC also exist like sampling error in

Introduction the form of improper technique, micrometastasis,
Lymph nodes are a site for organized collections of benign epithelial inclusions, partial lymph node
lymphoreticular tissue and are pink-gray bean- involvement by lesion, and a very small lymph node
shaped encapsulated organs. They are located at where sampling is difficult, also a high incidence of
anatomically constant points along the course of false results [6].
lymphatic vessels. The common sites of distribution
are cervical, axillary, mediastinal, retroperitoneal, Materials and Methods
iliac, and inguinal regions. Lymphadenopathy is the
Type of study: Prospective study
most common clinical presentation in outpatient
department patients which consists of various Place and Duration of Study: This prospective
etiological factors ranging from inflammatory to a study was carried out in the Department of
malignant condition [1]. The most common cause of Pathology at Maharajah's Institute of Medical
peripheral lymphadenopathy in our setting is an Sciences, Vizianagaram for a period of one year
inflammatory reaction to a microbial challenge, from March 2017 to March 2018.
followed by lymphomas and malignant metastatic
Sample size: A total of 210 patients of all age
deposits.
groups underwent FNAC of enlarged lymph nodes
The common etiological factors for during this study period.
lymphadenopathy tend to be considered as reactive,
Inclusion criteria: All patients presenting with
tuberculous, or malignant metastases. Overall,
lymph node enlargement were included in the study.
infective conditions (reactive and tuberculous) are
responsible for the majority of lesions. M. Exclusion criteria: Those patients with aspirated
tuberculosis is the most common cause of material were either inadequate or smears were
granulomatous lymphadenitis in India [2-4]. Fine- unsatisfactory for evaluation and a known case of
needle aspiration cytology (FNAC) is a clinical malignancy were excluded from this study.
technique used to obtain cells, tissues, and/or fluid
through a thin needle attached with a disposable Sample collection and method: After obtaining
syringe for the diagnosis of masses [5]. Lymph node the Ethical Committee Clearance from our
aspiration is of great value in diagnosing institution, Patients age, sex, site, duration were
lymphadenitis, lymphomas, and metastatic noted and full clinical examination to look out for
carcinoma [6]. other node enlargement were noted. FNAC was
performed after taking consent and explaining the
Aspiration of lymph nodes for diagnostic purposes procedure to the patient. FNAC was done using a 5-
was first done by Griey and Gray in 1904, in 10 ml disposable syringe with a 22-24 gauge
patients with sleeping sickness [7]. Lymph nodes needle. Two-three passes were done in all patients
are among the commonly aspirated organs for and four smears were made for each site of
diagnostic purposes [8]. In 1927, Dudgeon and aspiration.
Patrick were the first to use FNAC in diagnosing
tuberculous lymphadenitis [9]. De May has Two smears were fixed immediately in isopropyl
summarized the advantages of FNAC with the alcohol and stained with Papanicolaou (Pap) stain
acronym SAFE means Simple, Accurate, Fast, and and Hematoxylin & Eosin (H&E) and the other two
Economical [10]. The diagnostic yield of FNAC can were air-dried stained with Giemsa stain and where
be improved if it is accompanied by radiological ever tuberculosis was suspected the Ziehl Nelson
guidance like ultrasonography and computed (ZN) stain was done. Cytomorphological findings
tomography scan [11]. like cell population, areas of necrosis, and pattern
were assessed by examination under low power,
In 1847, Kun had done the pioneering act of first high power, and oil immersion.
time reporting the use of aspiration biopsy. Since
then fine needle aspiration cytology (FNAC) has Statistical analysis: Statistical analysis was
been a rapid, simple, safe, reliable minimally performed by the SPSS program for Windows,
invasive, and inexpensive method of establishing version 17.0 (SPSS, Chicago, Illinois). Categorical
the diagnosis of lesions and masses in various sites variables are presented as absolute numbers and
and organs and is the most convenient bedside percentages.
diagnostic aid [12,13,14,15,16].
426 Tropical Journal of Pathology and Microbiology 2020;6(7)
 Sitalata C. et al: A study on evaluation of the role of fine-needle

Epithelioid cell granulomas with caseous 58 14 (23.3%)

Results necrosis (59.18%)

Caseous necrosis without granulomas 14 37 (61.67%)

A total of 1100 cases were aspirated in the
(14.28%)
cytopathology section over one year from March
Total 98 60
2017 to March 2018, out of which 210 (19.1%)
cases were lymph node FNACs. Out of 210 patients Granulomatous lymphadenitis was diagnosed based
with palpable lymphadenopathy, in two cases the on the presence of epithelioid cell granuloma with or
FNAC was inconclusive due to unsatisfactory smear without giant cells and the absence of necrosis.
preparation. There were 86 (40.95%) female and Suppurative lymphadenitis cases showed
124 (59.05%) male patients with the age of the predominantly polymorphonuclear leukocytes,
patients ranged from 1 to 80 years. The maximum necrotic debris, and other lymphoid cells.
number of cases falling in the range between 21-40
years (128 cases, 60.95%), followed by 40-80 years Discussion
(63 cases, 30.01%) and 19 cases (9.04%) in the
range of 0-10 years. FNAC forms an important tool to aid in the diagnosis
of lymphadenopathy. Lymphadenopathy is one of
Among common cytological lesions found in our the commonest clinical presentations of various
study were tubercular lymphadenitis 98 cases disease processes presents inside the body. This
(46.67%) followed by reactive hyperplasia 35 cases study was carried out to find out the relative
(16.67%), metastatic carcinoma 29 (13.8%), frequencies of various etiology factors presenting as
granulomatous lymphadenitis 27 (12.85%), non- lymphadenopathy in different age groups and
specific lymphadenitis 8 (3.8%), acute suppurative cytomorphological changes in the different lesions.
lymphadenitis 7 (3.33%) and lymphoma 4 (1.8).
Among the age group which was studied range from
Table-1: Cytological diagnosis of 1-80 years with maximum cases ranged 21-40
lymphadenopathy. years which is comparable with those of Shreshtha
Cytologic diagnosis Number of cases Percentage et al [17], A. B. Pandav et al [18], and A. K.
Tubercular lymphadenitis 98 46.67 Kochhar et al [13]. In our study, a male
Reactive hyperplasia 35 16.67 preponderance was noted and similar male
Granulomatous lymphadenitis 29 13.8 preponderance was correlated with Hirachand et al
Metastatic carcinoma 27 12.85 [19] and Shreshtha et al [17].
Non-specific lymphadenitis 8 3.8
Tuberculous lymphadenitis was the most common
Suppurative lymphadenitis 7 3.33
lesion and was reported in 98 cases (46.67%) which
Hodgkins lymphoma 3 1.4
correlated with the study by Ruchi K et al [20]
Non Hodgkins lymphoma 1 0.4
(52.3%) and A B Pandav et al [18] (50.53%).
Unsatisfactory 2 0.9

Total 210 In our study cytomorphological pattern was

Epithelioid cell granulomas with caseous necrosis
The lymph node aspirates were found to be (59.18%) in the present study, which is closely
diagnosed as tubercular lymphadenitis based on the comparable with Goswami et al [21] (50%). AFB
presence of epithelioid cell granulomas and caseous positivity was maximum with necrosis without
necrosis with or without Langhan’s giant cells or ZN granulomas pattern (61.67%) followed by
positivity. Among these, 60 cases were Ziehl- epithelioid cell granulomas with necrosis pattern
Nelson staining positive. Further cytomorphologic (23.3%) which correlated with findings of Goswami
patterns in tubercular lymphadenitis as follows. et al. [21].

Table-2: Correlation of cytomorphological The second most common cytological diagnosis was
features in TB lymphadenitis with AFB reactive hyperplasia was seen in 35 cases
positivity. (16.67%). Similar findings were also observed in A
Cytomorphological features No. of cases AFB K Kochhar et al [13]. Granulomatous lymphadenitis
(%) positivity was seen in 29 cases (13.8%) correlates with
Epithelioid cell granulomas without caseous 26 (26.53%) 9 (15%) studies by Hirachand et al [19] (9.2%).
necrosis Granulomatous lymphadenitis can be classified as
non-infectious and infectious.

Tropical Journal of Pathology and Microbiology 2020;6(7) 427

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