Categorization of Lymph Node Aspirates using the Proposed Sydney System with assessment of Risk of Malignancy and Diagnostic Accuracy

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.

Download Full-text

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

Cancer Cytopathology ◽

10.1002/cncy.22432 ◽

2021 ◽

Author(s):

Parikshaa Gupta ◽

Nalini Gupta ◽

Pankaj Kumar ◽

Sunny Bhardwaj ◽

Radhika Srinivasan ◽

...

Keyword(s):

Lymph Node ◽

Sydney System ◽

Risk Of Malignancy

Download Full-text

Evaluation of Mediastinal Lymph Node Metastasis in Lung Cancer: Factors influencing the Diagnostic Accuracy ofCT

Journal of the Korean Radiological Society ◽

10.3348/jkrs.1998.38.3.445 ◽

1998 ◽

Vol 38 (3) ◽

pp. 445

Author(s):

Du Hwan Choe ◽

Tae Hyun Lee ◽

Kie Hwan Kim ◽

Soo Yil Chin ◽

Jae Ill Zo ◽

...

Keyword(s):

Lung Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Diagnostic Accuracy ◽

Mediastinal Lymph Node ◽

Mediastinal Lymph Node Metastasis ◽

Node Metastasis ◽

Factors Influencing

Download Full-text

CT diagnosis of ilioinguinal lymph node metastases in melanoma using radiological characteristics beyond size and asymmetry

BJS Open ◽

10.1093/bjsopen/zraa005 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

M J Wilkinson ◽

H Snow ◽

K Downey ◽

K Thomas ◽

A Riddell ◽

...

Keyword(s):

Lymph Node ◽

Diagnostic Accuracy ◽

Multivariable Analysis ◽

Ct Scans ◽

Non Invasive ◽

Poor Predictor ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

Node Metastases

Abstract Background Diagnosis of lymph node (LN) metastasis in melanoma with non-invasive methods is challenging. The aim of this study was to evaluate the diagnostic accuracy of six LN characteristics on CT in detecting melanoma-positive ilioinguinal LN metastases, and to determine whether inguinal LN characteristics can predict pelvic LN involvement. Methods This was a single-centre retrospective study of patients with melanoma LN metastases at a tertiary cancer centre between 2008 and 2016. Patients who had preoperative contrast-enhanced CT assessment and ilioinguinal LN dissection were included. CT scans containing significant artefacts obscuring the pelvis were excluded. CT scans were reanalysed for six LN characteristics (extracapsular spread (ECS), minimum axis (MA), absence of fatty hilum (FH), asymmetrical cortical nodule (CAN), abnormal contrast enhancement (ACE) and rounded morphology (RM)) and compared with postoperative histopathological findings. Results A total of 90 patients were included. Median age was 58 (range 23–85) years. Eighty-eight patients (98 per cent) had pathology-positive inguinal disease and, of these, 45 (51 per cent) had concurrent pelvic disease. The most common CT characteristics found in pathology-positive inguinal LNs were MA greater than 10 mm (97 per cent), ACE (80 per cent), ECS (38 per cent) and absence of RM (38 per cent). In multivariable analysis, inguinal LN characteristics on CT indicative of pelvic disease were RM (odds ratio (OR) 3.3, 95 per cent c.i. 1.2 to 8.7) and ECS (OR 4.2, 1.6 to 11.3). Cloquet’s node is known to be a poor predictor of pelvic spread. Pelvic LN disease was present in 50 per cent patients, but only 7 per cent had a pathology-positive Cloquet’s node. Conclusion Additional CT radiological characteristics, especially ECS and RM, may improve diagnostic accuracy and aid clinical decisions regarding the need for inguinal or ilioinguinal dissection.

Download Full-text

Role of human epididymis protein 4 for detection of ovarian carcinoma in adnexal masses: A pilot study

10.1055/s-0039-1685305 ◽

2016 ◽

Author(s):

Nidhi Bansal ◽

A. Suneja ◽

K. Guleria ◽

N. B. Vaid ◽

K. Mishra ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Cross Sectional Study ◽

Ca 125 ◽

Serum Samples ◽

Cross Sectional ◽

Adnexal Masses ◽

Good Discriminator ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index ◽

Benign Tumours

Introduction: HE4 is a novel tumour biomarker used for early diagnosis of ovarian cancer. This study evaluated the diagnostic accuracy of HE4 alone and in combination with CA125, risk of malignancy index (RMI), risk of malignancy algorithm (ROMA). Methods: It was a cross sectional study conducted recruiting 88 women with adnexal masses who were planned for surgery. After baseline work up and ultrasound examination, serum samples were collected for estimation of CA 125 and HE4 levels. Serum HE4 levels were estimated using ELISA kit. RMI and ROMA score were calculated and diagnostic accuracy of HE4, CA 125, RMI, ROMA and their combination were compared. Cut off for HE4 and ROMA score were calculated using ROC curve. Results: Of 88 subjects, 66 were analyzed with 19 malignant (including 5 LMP) and 47 benign cases. The median value of HE4 among malignant cases was found to be significantly higher than among the benign cases. PPV and NPV of HE4 at a cut off 130.8 pMol/ml was 85.7% and 77.9% respectively. Highest PPV (88.9%) with acceptable NPV (80.7%) was found with ROMA followed by HE4 (PPV 85.7%; NPV 77.97%), RMI (PPV 76.92%; NPV 83%) and CA125 (PPV 52%; NPV 80.85%). Conclusion: HE4 levels were lower in Indian population both in malignant and benign tumours as compared to other studies. HE4 is a good discriminator and gives best accuracy when it is combined with CA125 in a logistic algorithm, ROMA.

Download Full-text

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

Acta Cytologica ◽

10.1159/000517314 ◽

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

Introduction: 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. Materials and Methods: 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. Results: We analyzed 363 USFNAs of lymphadenopathies. The distribution of cases by categories was as follows: insufficient (n = 13; 3.58%), benign (n = 208; 57.30%), atypia of uncertain significance (n = 7; 1.93%), suspicious (n = 21; 5.79), and malignant (n = 114; 31.40%). The risks of malignancy calculated for categories I, II, III, IV, and V were 27%, 3%, 50%, 100%, and 100%, respectively. Conclusion: 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.

Download Full-text