Role of FNAC in diagnosis of cervical lymphadenopathy.
Lymphadenopathy is the most common cause of swelling in the neck and is one of the commonest presentations in inflammatory and neoplastic disorders.  FNAC has been successfully adopted as a routine technique to diagnose the cause of lymphadenopathy in our centre. FNAC is a simple, quick, and inexpensive and is equally reliable procedure which can be used as a routine OPD procedure for diagnosis of lymphadenopathy.  FNAC does not give same architectural detail as histology but it can provide cells from the entire lesion as many passes through the lesion can be made while aspirating. 
Materials and Methods
This study was carried out at GMERS Medical College and Hospital, Valsad, on 196 clinically diagnosed cases of cervical lymphadenopathy over a period of two years from January 2010 to December 2011. In each case detailed history, clinical presentation of cervical lymph nodes and clinical examination were carried out. Aspiration was done as outdoor procedure using 23 gauge needles. Three to four smears were prepared from aspirated material. Smears were dipped immediately in the ether alcohol solution for minimum of 30 minutes and H &E staining carried out. The diagnoses were classified according to various cytomorphological patterns  and correlated with patient's age.
A total of 196 cases were included in this study. Maximum number of cases 93 (53.27%) were in age group of 11-30 years. The various causes of cervical lymphedenopathy were classified according to cytomorphological patterns  and their frequency of occurrence in relation with different age groups is shown in Table 1.
The present study of 196 patients clinically diagnosed with cervical lymphadenopathy cytomorphologically showed tuberculous lymphadenitis as a most frequent 109 (55.61%) cause of lymphadenopathy followed by chronic non-specific lymphadenitis 49 (25.00%), metastatic carcinoma 21 (10.71%), acute lymphadenitis 15 (7.65%), and lymphoma 2 (1.02%). Inflammatory lesion (88.26%) predominated as compared to malignancy (11.76%). Majority patients with cervical lympadenopathy were in the age group of 11 to 30 years (45-90%) which is comparable with studies by P Bhargav et al.  and S Rajeshekaran et al.  Tuberculosis is most frequent below the age of 40 whereas malignancy predominated after the age of 40, which is comparable with those of other studies by Amitkumar Bapuso Pandav, Pramila Prakash Patil. 
FNAC is an outpatient procedure that is cost effective and results are obtained quickly.  FNAC has revolutionized the diagnosis of cervical lymphadenopathy, decreasing the morbidity of excision or incision biopsy of lymph node.  Cervical lymphadenopathy is a common problem faced by health care professionals. 
Lymph node cytology is useful for the clinicians to know whether the lymphadenopathy is due to infection, metastatic malignancy or lymphoma. 
The expansion of FNAC in primary diagnosis of lymphoma has been enormous and successful with aids of recent advances like Immunohistochemistry and flow cytometry. [11,12]
The present study confirmed that FNAC of lymph node is an excellent first line method for investigating the nature of the lesion. Due to poor preservation of architecture by improper fixation and being a cellular organ, histopathology of lymph node may cause diagnostic problem to pathologist. In these situations, fine needle aspiration cytology definitely has upper hand over biopsy in making diagnosis. Commonest diseases causing Cervical Lymphadenopathy are Tuberculosis, Metastatic Malignancies and chronic non-specific lymphadenitis. We feel that though FNAC is considered complimentary to biopsy, in proper clinical setting and in certain situation it alone can help in establishing diagnosis.
Fine Needle Aspiration Cytology is a simple, safe, rapid, cost effective and reasonably accurate method of establishing the diagnosis of cervical lymphadenopathy. Its use is strongly recommended in early diagnosis and in case of tuberculosis it obviates excision biopsy and treatment can directly be started in patient.
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Kamini R Patel, Jignasha M Patel, Kamlesh J Shah, Niraj U Patel
Department of Pathology, GMERS Medical College, Valsad, Gujarat, India
Correspondence to: Kamini R Patel (firstname.lastname@example.org)
Received Date: 30.01.2014
Accepted Date: 11.04.2014
Table-1: Age wise distribution of cytomorphological patterns Cytomorphological Age Groups (Years) Diagnosis 0-10 11-20 21-30 31-40 Acute lymphadenitis 0 13 12 8 Chronic non-specific 9 13 12 8 lymphadenitis Tuberculosis 4 29 28 22 Hodgkin's lymphoma 0 1 0 0 Non-Hodgkin's lymphoma 0 0 0 0 Metastasis 0 0 2 1 Total 13 46 45 35 % 6.63 22.95 22.95 17.85 Cytomorphological Age Groups (Years) Diagnosis 41-50 51-60 >60 Acute lymphadenitis 3 1 1 Chronic non-specific 4 1 2 lymphadenitis Tuberculosis 16 6 4 Hodgkin's lymphoma 0 0 0 Non-Hodgkin's lymphoma 0 1 0 Metastasis 9 6 3 Total 32 15 10 % 16.32 7.65 5.10 Table-2: Relative distribution of cytomorphological pattern of diagnosis and distribution with respect to gender Cytological Diagnosis No. of case M F Total % Acute lymphadenitis 9 6 15 7.65 Chronic non-specific lymphadenitis 19 30 49 25.00 Tuberculosis 46 63 109 55.61 Hodgkin's lymphoma 0 1 1 0.51 Non-Hodgkin's lymphoma 1 0 1 0.51 Metastasis 16 5 21 10.71 Total 91 105 196 100 % 46.42 53.57 Table-3: Pathological Distribution of various cervical lymph nodes lesions as diagnosed on FNAC Cytological Diagnosis No. Of Cases Percentage Inflammatory lymphadenopathy 1) Acute lymphadenitis 2) Chronic non-specific 173 88.26 lymphadenitis 3) Tuberculous lymphadenitis Neoplastic 1) Primary 23 11.73 2) Secondary Total 196 100
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|Title Annotation:||RESEARCH ARTICLE; fine needle aspiration cytology|
|Author:||Patel, Kamini R.; Patel, Jignasha M.; Shah, Kamlesh J.; Patel, Niraj U.|
|Publication:||International Journal of Medical Science and Public Health|
|Date:||May 1, 2014|
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