Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Pathology

Background: FNAC is an important diagnostic technique in the screening of lymphadenopathies, forming a preferred method for evaluating a variety of pathologic processes in lymph node, including reactive, malignant changes and metastases, with ongoing revolutionary competition with pathologic biopsy in many cases. Materials and methods: Two hundreds and three cases with cervical lymph nodes FNAC performed at NCI Cairo University in the period ranged from the beginning of the year 2015 to the end of 2017 were reviewed, with adequate cytology(slides stained by Papanicolaou stain)and cell blocks when available, Subsequent surgery with available histopathology results were reviewed. The results were compared with the cytological interpretation for concordance and accuracy of FNAC. Comparison was done between the blindly aspirated cases and those that were aspirated under image guidance to accuracy between cytologic and pathologic diagnosis.Results: This study was conducted on 203 cases, age was from 10 up to 70 years, mean value was 45.85± SD 18.065. 110 cases (54.2%) females and 93 cases (45.8%) males, commonest site was upper deep cervical lymph nodes 127 cases (62.6%) then supraclavicular lymph nodes in 41 cases (20.2%). 19 cases (9.4%), 9 cases (4.4%), 3 cases (1.5%), 3 cases (1.5%), and 1 cases (0.5%)were in submandibular lymph nodes, lower deep cervical,auricular,submental, and prelaryngeal lymph nodes, respectively. Only 88 cases had available histopathology results. Sensitivity, specificity and diagnostic accuracy of FNAC was calculated using histopathology as a gold standard. Cyto-histopathologic correlation revealed that 12 cases had false negative diagnoses, their cytological diagnoses were reactive lesion (10 cases) and inflammatory lesions (2cases) while the histopathological diagnosis were malignant neoplasm. There are no false positive cases for malignancy. Sensitivity of cytology in diagnosis of cervical lymph nodes was 85.3%, specificity was 100%, PPV was 100% and NPV was 37%. The overall diagnostic accuracy of FNAC was 86.5%. Sonar guided FNAC improved the overall sensitivity and specificity of lymph node FNAC being 98.2% and 58.3%, respectively compared to 75% and 41.7% in the blindly aspirated cases.In conclusion: FNAC is a safe, simple and valuable method for the differentiation between reactive lesions and malignant lymph node lesions in order to avoid unnecessary surgery with a reliable sensitivity and high specificity

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