Assessment of risk of malignancy by application of the proposed Sydney system for classification and reporting lymph node cytopathology

2021 ◽  
Author(s):  
Parikshaa Gupta ◽  
Nalini Gupta ◽  
Pankaj Kumar ◽  
Sunny Bhardwaj ◽  
Radhika Srinivasan ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sydney System ◽  
Risk Of Malignancy

scholarly journals A Novel Approach to Classification and Reporting of Lymph Node Fine-Needle Cytology: Application of the Proposed Sydney System

Diagnostics ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1314
Author(s):  
Elena Vigliar ◽  
Gennaro Acanfora ◽  
Antonino Iaccarino ◽  
Massimo Mascolo ◽  
Daniela Russo ◽  
...  
Keyword(s):  
Lymph Node ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Diagnostic Category ◽  
Fine Needle ◽  
Fine Needle Cytology ◽  
Novel Approach ◽  
Sydney System ◽  
Risk Of Malignancy

Fine-needle cytology (FNC) is a useful diagnostic tool in the first line evaluation of lymphadenopathy of unknown aetiology. Nevertheless, considering the large number of conditions presenting as lymphadenopathy, lymph node cytology represents a challenging scenario. Recently, an expert panel published the proposal of the Sydney system for performing classification and reporting of lymph node cytopathology; the aim of the present study was to evaluate the applicability of this system. Thus, 300 lymph node FNCs performed over 1 year were reviewed and categorized according to the Sydney system classification. Overall, n = 20 cases (6.7%) were categorized as L1-inadequate/non-diagnostic; n = 104 (34.7%) as benign (L2); n = 25 (8.3%) as atypical (L3); n = 13 (4.3%) as suspicious (L4), and n = 138 (46%) as malignant (L5). FNC diagnoses were correlated with histopathologic and clinical follow-up to assess the diagnostic accuracy and the risk of malignancy (ROM) for each diagnostic category. Statistical analysis showed the following results: sensitivity 98.47%, specificity 95.33%, positive predictive value 96.27%, negative predictive value 98.08%, and accuracy 97.06%. The ROM was 50% for the category L1, 1.92% for L2, 58.3% for L3, and 100% for L4 and L5. In conclusion, FNC coupled with ancillary techniques ensures satisfactory diagnostic accuracy and the implementation of the Sydney system may improve the practice of cytopathologists.

Ultrasound-Guided Fine-Needle Aspiration of Superficial Lymphadenopathy Performed by Interventional Pathologists: The Applicability of the Sydney System from 2 Years of Experience and 363 Cases

2021 ◽  
pp. 1-10
Author(s):  
Héctor Enrique Torres Rivas ◽  
Karen Villar Zarra ◽  
Lisseth Andrea Pérez Pabón ◽  
María de la Paz González Gutierréz ◽  
Nuria Zapico Ortiz ◽  
...  
Keyword(s):  
Lymph Node ◽  
Retrospective Study ◽  
Fine Needle Aspiration ◽  
Diagnostic Procedure ◽  
Needle Aspiration ◽  
Ultrasound Guided ◽  
Fine Needle ◽  
Specialized Hospital ◽  
Uncertain Significance ◽  
Sydney System

<b><i>Introduction:</i></b> The Sydney system proposal for the study and reporting of lymphadenopathy by fine-needle aspiration (FNA) constitutes one of the first attempts to standardize this procedure. Here, we review its applicability. <b><i>Materials and Methods:</i></b> A retrospective study in which all ultrasound-guided FNAs (USFNAs) of superficial lymphadenopathy (palpable or not) performed by interventional pathologists in 2 specialized hospital centers were quantified over 2 years. The procedure was systematized, and the diagnoses were reclassified according to the Sydney system categories. <b><i>Results:</i></b> We analyzed 363 USFNAs of lymphadenopathies. The distribution of cases by categories was as follows: insufficient (<i>n</i> = 13; 3.58%), benign (<i>n</i> = 208; 57.30%), atypia of uncertain significance (<i>n</i> = 7; 1.93%), suspicious (<i>n</i> = 21; 5.79), and malignant (<i>n</i> = 114; 31.40%). The risks of malignancy calculated for categories I, II, III, IV, and V were 27%, 3%, 50%, 100%, and 100%, respectively. <b><i>Conclusion:</i></b> The implementation of the Sydney system allows the systematization and standardization of the lymph node FNA methodology, with increased efficacy and efficiency. Assimilating the recommendations enables the qualification of the diagnostic procedure.

scholarly journals Core Biopsy and FNA: A Comparison of Diagnostic Yield in Lymph Nodes of Different Ultrasound Determined Malignant Potential

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 37s-37s
Author(s):  
B. May ◽  
A. Rossiter ◽  
P. Heyworth
Keyword(s):  
Lymph Node ◽  
High Risk ◽  
Lymph Nodes ◽  
Clinical Experience ◽  
Core Biopsy ◽  
Diagnostic Yield ◽  
Sampling Technique ◽  
Malignant Potential ◽  
Low Risk ◽  
Risk Of Malignancy

Background: The tissue diagnosis of lymphoma and metastases is commonly obtained from affected lymph nodes. The lymph nodes chosen for biopsy are often the consequence of their appearance on ultrasound, which determines their risk of malignancy. Two frequently used percutaneous sampling techniques are core biopsy and fine needle aspiration (FNA). While core biopsy obtains a larger tissue sample and provides a degree of architectural information, FNA is considered less invasive and has the advantage of immediate confirmation of adequacy by the attending cytologist. Anecdotally, core biopsy is more commonly used when a lymph node is suspected of harboring neoplasia, however a feature of malignancy is hypercellularity, which theoretically should increase the diagnostic yield of FNA. Aim: The aim of this project was to compare the diagnostic capability of FNA and core biopsy in lymph nodes of different malignant potential, as defined by ultrasound, and determine if the radiologic appearance can guide clinicians in their choice of sampling technique. The project also reviewed the role of clinical experience in both the choice of sampling technique and diagnostic yield. Methods: Retrospective study of percutaneous lymph node biopsies performed at a large tertiary hospital between July 2016 and March 2018. The associated ultrasounds were reviewed and the lymph nodes were classified as high or low risk of malignancy by their sonographic appearance. The end point for analysis was the capacity for FNA or core biopsy to provide a definitive diagnosis. The diagnostic yield was then separately assessed for lymph nodes of high and low malignant potential. The effect of clinical experience on diagnostic yield was also examined, by comparing the outcomes of radiology consultants and radiology trainees. Results: 296 lymph node biopsies were reviewed and statistical analysis was performed using logistic regression analysis. Core biopsy, in comparison with FNA, was used twice as often in lymph nodes of high malignant potential, supporting the aforementioned anecdotal evidence. Core biopsy demonstrated superior diagnostic yield in comparison with FNA, providing a diagnostic sample 45% ( P = 0.313) more often in low-risk lymph nodes and 209% ( P = < 0.05) more often in high-risk lymph nodes. Consultant radiologists used FNA 81% more often than core biopsy in lymph nodes of high malignant potential, while radiology trainees used core biopsy 104% more often than FNA in the same group. In high-risk lymph nodes, trainees were 117% ( P = 0.105) more likely to obtain a diagnostic sample than consultants. Conclusion: Core biopsy is superior to FNA in the tissue sampling of lymph nodes regardless of ultrasound determined risk of malignancy. Biopsies obtained by radiology trainees provided a diagnosis twice as often as those obtained by radiology consultants. This appeared to be the consequence of consultant preference for FNA over core biopsy.

scholarly journals Accuracy and Reproducibility of Endoscopic Ultrasound B-Mode Features for Observer-Based Lymph Nodal Malignancy Prediction

Respiration ◽  
2021 ◽  
pp. 1-9
Author(s):  
Roel L.J. Verhoeven ◽  
Fausto Leoncini ◽  
Jorik Slotman ◽  
Chris de Korte ◽  
Rocco Trisolini ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Endoscopic Ultrasound ◽  
Area Under The Curve ◽  
Objective Measure ◽  
Future Research ◽  
Malignancy Risk ◽  
Nodal Size ◽  
Risk Of Malignancy ◽  
Roc Area

<b><i>Background:</i></b> Endoscopic ultrasound routinely guides lymph node evaluation for the staging of a known or suspected lung cancer. Characteristics seen on B-mode imaging might help the observer decide on the lymph nodes of risk. The influence of nodal size on the predictivity of these characteristics and the agreement with which operators can combine these for malignancy risk prediction is to be determined. <b><i>Objectives:</i></b> We evaluated (1) if prospectively scored individual B-mode ultrasound features predict malignancy when further divided by size and (2) assessed if observers were able to reproducibly agree on still lymph node image malignancy risk. <b><i>Methods:</i></b> Lymph nodes as visualized by EBUS were prospectively scored for B-mode characteristics. Still B-mode images were furthermore collected. After collection, a repeated scoring of a subset of lymph nodes was retrospectively performed (<i>n</i> = 11 observers). <b><i>Results:</i></b> Analysis of 490 lymph nodes revealed the short axis size is an objective measure for stratifying risk of malignancy (ROC area under the curve 0.78). With ≥8-mm size, 210/237 malignant lymph nodes were correctly identified (89% sensitivity, 46% specificity, 61% PPV, and 81% NPV). Secondary addition of B-mode features in &#x3c;8-mm nodes had limited value. Retrospective analysis of intra- and interobserver scoring furthermore revealed significant disagreement. <b><i>Conclusions:</i></b> Lymph nodes of ≥8-mm size and preferably even smaller should be aspirated regardless of other B-mode features. Observer disagreement in scoring both small and large lymph nodes suggests it is infeasible to include subjective features for stratification. Future research should focus on (integrating) other (semi)quantitative values for improving prediction.

Real‐world experience with the Sydney System on 1458 cases of Lymph Node Fine‐Needle Aspiration Cytopathology.

Cytopathology ◽  
2021 ◽  
Author(s):  
Alessandro Caputo ◽  
Valeria Ciliberti ◽  
Antonio D'Antonio ◽  
Angela D'Ardia ◽  
Rosalba Fumo ◽  
...  
Keyword(s):  
Lymph Node ◽  
Fine Needle Aspiration ◽  
Real World ◽  
Needle Aspiration ◽  
Fine Needle ◽  
Sydney System

Scanning electron microscopy of freeze-fractured prescapular lymph node of caprine

1984 ◽  
Vol 42 ◽  
pp. 244-245
Author(s):  
O. Faroon ◽  
F. Al-Bagdadi ◽  
T. G. Snider ◽  
C. Titkemeyer
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Lymphatic System ◽  
Three Dimensional ◽  
Meat Products ◽  
The Body ◽  
Morphological Data ◽  
The World ◽  
Cellular Constituent ◽  
Scanning Electron

The lymphatic system is very important in the immunological activities of the body. Clinicians confirm the diagnosis of infectious diseases by palpating the involved cutaneous lymph node for changes in size, heat, and consistency. Clinical pathologists diagnose systemic diseases through biopsies of superficial lymph nodes. In many parts of the world the goat is considered as an important source of milk and meat products.The lymphatic system has been studied extensively. These studies lack precise information on the natural morphology of the lymph nodes and their vascular and cellular constituent. This is due to using improper technique for such studies. A few studies used the SEM, conducted by cutting the lymph node with a blade. The morphological data collected by this method are artificial and do not reflect the normal three dimensional surface of the examined area of the lymph node. SEM has been used to study the lymph vessels and lymph nodes of different animals. No information on the cutaneous lymph nodes of the goat has ever been collected using the scanning electron microscope.

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