Cytological Study of Lymph Nodes in Head and Neck Region - Pattern, Reliability and Limitations

BACKGROUNDFine needle aspiration cytology (FNAC) is of particular relevance in the head and neck area because of the easy accessibility of target sites and excellent patient compliance due to the minimally invasive nature of the technique. It is a valuable initial diagnostic procedure and efficient for follow up. AIMS AND OBJECTIVESTo categorise all the lymph node swellings in the head and neck region and their statistical analysis. To study the various gross and cytomorphological features of lesions. To evaluate the diagnostic accuracy, sensitivity and specificity of fine needle aspiration technique by correlating cytological and histopathological diagnosis. METHODSWe prospectively studied patients referred to the cytology department with clinical diagnosis of lymph nodes swelling in head and neck from July 2011 to June 2013. Detail clinical, cytological and histopathological findings were noted. RESULTThe technical accuracy rate was 96.12% with 1390 adequate lymph node aspirates. The non neoplastic and benign lesions were 1268 (91.22%) while 122 (8.77%) were malignant. Granulomatous lymphadenitis was the most common cause for enlarged lymph nodes in younger while metastatic malignancies were common in elderly. Diagnosis of 67 cases was confirmed on histopathological examination with sensitivity of 100 % and specificity of 97.87 %. CONCLUSIONFNAC is a gold standard for preoperative assessment of head and neck lymph nodes. Early and accurate diagnosis reduces surgical intervention, morbidity and mortality. It is safe, easy, fast, accurate, effective, easy to perform, minimally invasive and cost effective method. Key WordsFNAC, Head and neck region lymph nodes, Histopathology INTRODUCTION Tuberculosis is commonest infectious disease of developing world and tuberculous lymphadenopathy is a most common manifestation of extrapulmonary tuberculosis. [1,2] In the evaluation of enlarged lymph nodes, fine needle aspiration cytology (FNAC) is widely accepted accurate, sensitive, specific and cost effective method and is especially proven valuable in the diagnosis of tuberculosis and in metastatic cervical lymph node. This study was done to find out frequency of non neoplastic lesions at cervical lymph nodes with special reference to tuberculosis with variables like age and sex distribution, role of clinical assessment and history, aspiration and cytological findings and spectrum of cytomorphology with histopathological correlation. MATERIALS AND METHODS The present prospective study of head and neck lymph nodes by fine needle