Enlarged lymph node is one of the most frequent clinical manifestations of patients visiting the outpatient department subjected to FNAC. It is the first line of investigation in evaluating lymphadenopathy due to the frequent involvement of lymph nodes in regional and systemic disease & due to easy accessibility. Thus, it is often used as a safe substitute for excision biopsy. The present study aimed to study the clinical and cytomorphological features of enlarged Lymph nodes by Fine Needle Aspiration Cytology in patients with Lymphadenopathy. The objective of the study was to describe the cytomorphological features of enlarged Lymph nodes involved in various etiologies, to categorize clinical features in patients with lymphadenopathy, to assess the frequency of lymphadenopathy in different age groups and gender, and to categorize varied etiologies of Lymph node enlargement according to site. It was an observational study. A total of 155 cases with enlarged lymph nodes were studied during the study period from December 2020 to November 2022. The present study found that out of 155 cases, 149 cases (96.12%) were adequate for cytological diagnosis. The study showed slight male preponderance with M: F ratio of 1.06:1, mean age was 45 years. Fever was the most common clinical presentation besides lymphadenopathy, with 53.33% of cases. The cervical group of lymph nodes was the most common group of lymph nodes affected at 41.29%. Of 149 cases, non-neoplastic lesions accounted for 92.61%, and neoplastic lesions for 7.38%. Among the non-neoplastic lesions, caseating tubercular lymphadenitis was the most common finding accounting for 39.85% of cases, followed by reactive lymphadenitis in 35.50%, granulomatous lymphadenitis in 13.04% of cases, suppurative lymphadenitis in 7.24% & cold abscess in 2.89% cases. Infectious mononucleosis and Parasitic infestation were found in one case each. Among the neoplastic lesions, metastasis in the lymph nodes was more common than primary lymphomas; the most commonly involved lymph node was the cervical lymph node. Metastasis from squamous cell carcinoma was seen in 36.36% of cases, metastasis from adenocarcinoma was seen in 9.09% of cases, and from other sites was seen in 36.36% of cases. The present study concluded that tuberculous lymphadenitis is still rampant, the most common cause of lymphadenopathy. FNAC is an excellent diagnostic procedure that can establish a rapid cytological diagnosis in non-neoplastic and neoplastic lesions of lymph nodes and helps in patient care management.
Malhotra AS, Lahori M, Nigam A, Khajuria A. Profile of lymphadenopathy: an institutional-based cytomorphological study. Int J Appl Basic Med Res. 2017;7(2):100-3. doi: 10.4103/2229-516X.205812, PMID 28584739.
Florence K, Suresh K, Lavanya K. Cytopathological study of lymph node Lesions – A2 Years Retrospective Study. IANT J Sci Stud. 2018:118-22.
Dorfman RF, Warnke R. Lymphadenopathy simulating the malignant lymphomas. Hum Pathol. 1974;5(5):519-50. doi: 10.1016/s0046-8177(74)80005-5, PMID 4137045.
Pavithra P, Geeta JP. The role of fine needle aspiration cytology in evaluating the spectrum of lymph node lesions. Int J Pharm Biol Sci. 2014;5:377-84.
Ajmall F, Imran A. Comparison of FNAC vs. excision biopsy for suspected tuberculous cervical lymphadenopathy. Ann King Edward Col. 2013;9:216-8.
Sharma RI, Dharaiya CM. Study of fine needle aspiration cytology of lymphadenopathy in a tertiary care center of Ahmedabad, Gujarat. Trop J Path Micro. 2018;4(3):258-64.
Ferrer R. Lymphadenopathy: differential diagnosis and evaluation. Am Fam Phys. 1998 Oct 15;58(6):13-13-20.
Shrivastav A, Shal HA, Srivastav G, Santwani PM. Utility of acid-fast staining and re-aspiration in tubular lymphadenopathy −3 years study at a tertiary center. Int J Med Sci Public Health. 2013;2:875-9.
Arora B, Beena KR. Utility of FNAC in lymphadenopathies. J Cytol. 1999;16(2):61-6.
Pinkiewicz M, Dorobisz K, Zato?ski T. A systematic review of cancer of unknown primary in the head and neck region. Cancer Manag Res. 2021 Sep 18;13:7235-41. doi: 10.2147/CMAR.S319179, PMID 34566429.
Ingle SB, Hinge CR. Fine needle aspiration cytology [FNAC]- review;10(15):20-5:Article.IJCRR.2018.
Ha HJ, Lee J, Kim DY, Kim J-S, Shin M-S, Noh I, et al. Utility and Limitations of Fine Aspiration Cytology in the Diagnosis of Lymphadenopathy. Diagnostics. 2023;13(4):728. doi: 10.3390/diagnostics13040728.
Al-Mulhim AS. AL-Ghands, AL-Marzooq YM et al. The role of FNAC and imprint cytology in cervical lymphadenopathy. Saudi Med J. 2004;7:862-5.
Danos ML, Keebler CM. Cytopreparatory techniques. In: Keebler CM, Reagan JW, editors. The manual of cytotechnology. 4th ed. Chicago: American Society of Consultant Pharmacists Press; 1975. p. 262-317.
Bain BJ, Bates I, Laffan MA, Lewis SM. Preparation and staining methods for blood and bone marrow films. 12th ed. ELSEVIER Limited; 2017. p. 53-4.
Sharma P, Rana S, Gill MK, Singh P, Satarkar RN, Kalhan S. Spectrum of lymph node lesions on cytology in rural Haryana: a retrospective analysis. Int J Res Med Sci. 2015;3(5):1125-30. doi: 10.5455/2320-6012.ijrms20150518.
Duraiswami R, Margam S, Chandran P, Prakash A. Spectrum of pathologies on FNAC evaluation of peripheral lymph nodes at a tertiary care center in Hyderabad: a retrospective study. Int J Adv Med. 2017;4:27-33.
Gayen DP, Ghosh DS, Naskar DS. Study of fine needle aspiration cytology evaluation of peripheral lymph nodes. Int J Med Res Rev. 2019;7(4):259-65. doi: 10.17511/ijmrr.2019.i04.02.
Vimal S, Dharwadkar A, Chandanwale SS, Vishwanathan V, Kumar H. Cytomopholoical study of lymph node lesions: A study of 187 cases. Med J DYPatil Univ. 2016;9:43-50.
Kamaal M, Maheshwari U, Dhar. Diagnostic value of fine needle aspiration cytology in enlarged cervical lymph nodes in Tertiary Care Hospital in Navi Mumbai, Maharashtra, India. MGM J Sci. 2017;4(4):160-3. doi: 10.5005/jp-journals-10036-1163.
Patro P, Lad P, Hoogar MB, Dhar R, Sahu S et al. Spectrum of lesions of lymph nodes – a cytological study. Int J Health Sci Res. 2018;8(11):75-81.
Sharma DP, Devdhar DS, Chaudhary DA, Giri DS, Sharma DD. Cytomorphological profile of lymph nodes at a tertiary care Centre in Uttar Pradesh: A retrospective study. Int J Clin Diagn Pathol. 2021 Jan 1;4(1):23-7. doi: 10.33545/pathol.2021.v4.i1a.319.
Malhotra AS, Lahori M, Nigam A, Khajuria A. Profile of lymphadenopathy: an institutional-based cytomorphological study. Int J Appl Basic Med Res. 2017;7(2):100-3. doi: 10.4103/2229-516X.205812, PMID 28584739.
Majithia HJ, Algotar C, Chokshi T, Mori NK, Ghelani S. Cytomorphological study of lymph node lesions. IP Arch Cytol Histopathol Res. 2020;5(4):280-2.
Mitra SK, Mishra RK, Rai P. Cytomorphological patterns of tubercular lymphadenitis and its comparison with Ziehl – Neelsen staining and culture in eastern up. Gorakhpur Reg:Cytological study of 400 cases. J Cytol. 2017;34:139-43.
BhattSingh S, Singh S, Chalise SR. The cytopathological pattern of tuberculosis lymphadenitis:an analysis of 126 cases in tertiary care hospital. Int J Res Med Sci. 2018;6:1898-901.
Anand B, Mariaselvam A. Cytomorphology of lymphadenopathy with report on patterns of tuberculous lymphadenitis in a resource–limited setting. J Curr Res Sci Med. 2020;6(1):45-50. doi: 10.4103/jcrsm.jcrsm_16_20.
Khajuria R, Goswamy KC, Singh K. Dubey vk. The pattern of lymphadenopathy on fine needle aspiration cytology in Jammu. JK Sci J Med Educ Res. 2006;8:157-9.
Singh A, Bhambani P, Nema SK. Diagnostic accuracy of FNAC in diagnosis for cause of lymphadenopathy: A hospital-based analysis. Int J Res Med Sci. 2013;1(3):271-7. doi: 10.5455/2320-6012.ijrms20130822.
Wilkinson AR, Mahore SD, Maimoon SA. FNAC in the diagnosis of lymph node malignancies: A simple and sensitive tool. Indian J Med Paediatr Oncol. 2012;33(1):21-4. doi: 10.4103/0971-5851.96964, PMID 22754204.
Chaudhary A, Patani P. Fine needle aspiration cytology features of metastatic deposits in peripheral lymph nodes. Int J Sci Stud. 2017;4(12):248-50.
Dedeepya M, Ramaswamy AS, Kumarguru BN, Udaya Kumar M. Cytomorphological patterns of lymph node aspirates. J Clin Diagn Res. 2020 Oct;14(10):1-6.