Observational study on FNAC evaluation of peripheral lymph node swellings

Introduction: Peripheral lymphadenopathy is one of the common conditions encountered by clinicians. Knowledge of the pattern of diseases responsible for the same helps in better clinical decisions and management. The present study was conducted to assess the cytomorphological pattern of lymph node swellings by FNAC. Methods: The present study was cross-sectional in nature conducted upon 163 cases presenting with peripheral lymph node swellings for FNAC. Details of illness and findings of FNAC were noted. Results: Reactive hyperplasia was the most common finding in younger age groups (<20 years). Tuberculosis was more commonly seen in middle age groups (21-40 years). Malignant changes were more common in the elderly (>60 years). Conclusion: Reactive hyperplasia was the most common cause of lymphadenopathy in younger age groups was, tubercular lymphadenitis in the middle age group and metastatic carcinoma in patients above 60 years of age.

The results can be available in a short time, Observational study on FNAC evaluation of peripheral lymph node swellings Raj  Aims and objectives-The present study was conducted to assess the cytomorphological pattern of lymph node swellings by FNAC in patients presenting with peripheral lymph node swellings. Data collection procedure: The patients were cases with peripheral lymph node swellings referred to the laboratory by the clinicians for FNAC. History was taken from the patients and findings were noted. The patients were explained about the procedure and informed consent was taken from them.

Material and Methods
FNAC was done with aseptic precautions using 10 cc disposable syringe and 22/23-gauge needle by both aspiration and non-aspiration technique as required.
Smears were prepared on two slides. One of the slides was air-dried and stained with May-Grunwald Giemsa stain.
Another slide was wet fixed with alcohol and was stained with Papanicolaou stain. This was followed by careful microscopic examination and the cytological diagnosis was done. A pre-tested semistructured proforma was used for noting the findings.

Results
The present study included 163cases coming for FNAC of peripheral lymph node swellings. The age of the patients ranged from 2 to 79 years. Most of the cases belonged to the age group of 21-30 years.
There were 63.2% males and 36.8% females resulting in male: female ratio of 1.72:1. Cytomorphological features were used for diagnosis of pathology as discussed by Shah et al [14].      Tuberculosis was diagnosed when AFB was positive.
Microfilaria was also searched for in lymph node aspirate. Non-Hodgkin's lymphoma was diagnosed by the presence of a monomorphic population of lymphocytes scattered singly in a highly cellular smear and the absence of RS cell.
Diagnosis of Hodgkin's lymphoma (Figure-2)  Among the neoplastic lymph node lesions, the commonest was metastasis followed by lymphoma. Metastatic deposits were more common in the extremes of ages. Tuberculosis and granulomatous pathology were more common in the 10-40years [15].

Conclusion
It is concluded from the present study that the etiology of lymphadenopathy was different in different age groups. Reactive hyperplasia was the most common cause of lymphadenopathy in younger age groups, tubercular lymphadenitis in the middle age group and metastatic carcinoma in patients above 60 years of age. As there is the high rate of malignancy in the elderly, special precaution should be taken in doing FNAC in these patients in terms of preparation of more of wet fixed smears and keeping unstained smears which might be needed for further staining and studies. FNAC can be a reliable and convenient screening tool for the first-line diagnosis. For the cases in which diagnosis Is not confirmed, the further histological examination can be done for definitive treatment of the cases.

Limitations of the study-
The present study is observational in nature and only describes the clinical and cytological profile of peripheral lymph node swellings. Further study is needed to compare these findings with biopsy to assess the diagnostic value of FNAC.
What does the study add to the existing knowledge?
The findings of FNAC of peripheral lymph node swellings in this area have been described. The patient profile and pathological changes have been elaborated.

Author's contribution
Dr. Pulak Raj: Principal author collected data and has written the report.
Dr. Pawan Kumar Chaudhary: Edited the article, did a review of the literature and has written the discussion.