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

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.

Role of cytological examination in head neck masses

Background: Fine needle cytology can differentiate inflammatory and the neoplastic lesions. Moreover, the neoplastic lesions of the head and neck have a propensity to seed the subcutaneous tissues if overlying planes are widely violated, thereby fine needle cytology over an excision’s biopsy is the preferred choice. Methods: 106 patients with head and neck swelling were selected from the head-neck tumor clinic of the Oto-rhino-laryngology services, Dayanand medical college and hospital, Ludhiana, India. An analysis of the efficacy of fine needle aspiration cytology (FNAC) in the diagnosis of head and neck swellings was carried out.Results: Overall sensitivity of FNAC was 88.9% whereas overall specificity was 100%. Overall accuracy for salivary gland tumors was 100% for pleomorphic adenoma. FNAC from 50 subjects (56.2%) reported tubercular pathology. FNAC had to be repeated in 6.6% of the cases because of unsatisfactory smears. In 3 cases, false negative diagnosis was obtained and in 3 it was inconclusive.Conclusion: Properly executed FNAC is of the greater value in surgical practice with 88.9% sensitivity and 100% specificity.