Spectrum of Cytological Findings in Patients with Neck Lymphadenopathy - Experience in a Tertiary Care Hospital in Pakistan

Introduction: Lymph adenopathy is of great clinical significance as underlying diseases may range froma treatable infectious etiology to malignant neoplasms. In fact it is also essential to establish that the swellingin question is a lymph node. Fine needle aspiration cytology (FNAC) plays a vital role in solving these issues,nowadays being recognized as a rapid diagnostic technique because of its simplicity, cost effectiveness, earlyavailability of results, accuracy and minimal invasion. FNAC is particularly helpful in the work-up of cervicalmasses and nodules because biopsy of cervical adenopathy should be avoided unless all other diagnostic modalitieshave failed to establish a diagnosis.
Objective: To determine the epidemiological and cytomorphological patternsof enlarged neck nodes. Study Design: This retrospective observational study was performed at the Section ofHistopathology, Aga Khan University Hospital (AKUH), Karachi, Pakistan. Materials and
Methods: ThreeHundred and seventy seven (377) neck swelling specimens obtained over a period of two and a half yearsregistered from different regions of Pakistan were selected. Data were analyzed using SPSS 17.
Results: Of atotal of 377 cases of FNAC performed on neck nodes, the most frequent cause of lymphadenopathy was foundto be tuberculosis with 199 cases (52.7%), followed by reactive lymphoid hyperplasia with 61 cases (16.1%).Metastatic carcinoma was found to be the third most common cause with 33 cases (8.7%). A diagnosis oflymphoproliferative disorder was rendered in 21 cases (5.5%). Acute and chronic non-specific inflammation wasseen in 16 cases (4.2%). In 47 cases (12%) FNAC was inconclusive.
Conclusion: In our study, the predominantcause of enlarged neck nodes was tuberculous lymphadenitis, followed by reactive lymphadenitis and malignantneoplasm, especially metastatic carcinoma and lymphoma. FNAC was helpful in establishing the diagnosis inapproximately 98% of the cases.