|Year : 2022 | Volume
| Issue : 3 | Page : 234-239
Tuberculous and Nontuberculous Lesion of Lymphnodes − Histopathological and Cytological Correlation
Deep Patel, Jignasa Bhalodia, Shraddha J Patel
Department of Pathology, GMERS Medical College, Sola, Ahmedabad, Gujarat, India
|Date of Submission||14-Aug-2022|
|Date of Decision||10-Oct-2022|
|Date of Acceptance||16-Oct-2022|
|Date of Web Publication||07-Dec-2022|
Department of Pathology, B/142, Bhavna tenaments, Berej road vasna Ahmedabad, Gujarat
Source of Support: None, Conflict of Interest: None
Background: The lymph node is one of the major anatomic components of the immune system. Lymph nodes are the most widely distributed and easily accessible component of lymphoid tissue and hence they are frequently examined for diagnosis of lymphoreticular disorders. Lymph node swellings are one of the commonest clinical presentation of patients and it encompasses a wide spectrum ranging from inflammation to a malignant lymphoma or a more obnoxious metastatic malignancy. Aims and objectives: The aim of this study is to evaluate the diagnostic accuracy of Fine Needle Aspiration Cytology (FNAC) in correlation with histopathology in cases of cervical lymphadenopathies. Material and methods: Patients referred to the Department of Pathology, GMERS Medical College and Hospital, Sola Ahmedabad for period of 12 months from June 2021 to May 2022 for palpable lymph node swelling on whom FNAC procedure was performed were included in the study. FNAC diagnosis of patients was compared with histopathology in cases which underwent surgical excision and its diagnostic accuracy was studied. Results: Out of 100 cases which were included in the study, lymph node biopsy was carried out in all 100 cases. Most were in age group of 21 to 30 years. Gender wise, there was male preponderance. Benign lymphadenopathies were diagnosed in 93% of cases. Metastatic deposits were diagnosed in 7% of cases. On correlation of FNAC findings with histopathology, overall correlation rate was 85.2%. Conclusions: FNAC is especially helpful as lymphnode biopsy is a difficult and invasive procedure. Although excision biopsy is the gold standard, FNAC is preferred as first-line investigation.
Keywords: Fine needle aspiration cytology, histopathological, lymphadenopathies
|How to cite this article:|
Patel D, Bhalodia J, Patel SJ. Tuberculous and Nontuberculous Lesion of Lymphnodes − Histopathological and Cytological Correlation. MAMC J Med Sci 2022;8:234-9
|How to cite this URL:|
Patel D, Bhalodia J, Patel SJ. Tuberculous and Nontuberculous Lesion of Lymphnodes − Histopathological and Cytological Correlation. MAMC J Med Sci [serial online] 2022 [cited 2023 Feb 1];8:234-9. Available from: https://www.mamcjms.in/text.asp?2022/8/3/234/362896
| Introductions|| |
Lymph nodes are an integral component of the immune system and their enlargement is a common presentation in the clinical practice. The lymphoid system grows rapidly in childhood and achieves twice the adult size in early adolescence. The same starts regressing during mid-adolescence, it does not reach its stable adult size until 20 to 25 years. Lymph nodes are pink grey bean shaped encapsulated organs.
Lymph nodes are the most widely distributed and easily accessible component of lymphoid tissue and hence they are frequently examined for diagnosis of lymphoreticular disorders.,
The location where lymphadenopathy is found depends on the type of causes. Viruses, bacteria, and Mycobacterium causes cervical lymphadenopathy; supraclavicular lymphadenopathy is caused by Mycobacterium, metastasis; axillary lymphadenopathy by Staphylococcus, Streptococcus, Cat scratch disease, etc.; and inguinal lymphadenopathy is caused due to sexually transmitted diseases. One of the most common etiologies is tuberculosis which is very rampant in our country.
FNAC has become an integral part of initial diagnosis and management of patients presenting with lymphadenopathy. This simple technique has recently gained wide acceptance since it offers a high degree of accuracy, is less painful, cheap, repeatable, and useful for multiple lesions and has low risk of complications that is leading itself to outpatient diagnosis and thus making considerable saving in the cost of hospitalization.,
FNAC differentiates non neoplastic lesions from neoplastic lesions thus eliminating need of surgical intervention in these lesions which can be treated conservatively. But histopathological confirmation is mandatory in suspected, recurrent, and neoplastic lesions.
This diagnostic modality has gained considerable importance in the management of patients with lymphadenopathy over several years.
We are reporting histopathological correlation of 100 cases of lymphadenopathy with FNAC.
| Material and Methods|| |
A retrospective study was undertaken at GMERS Medical College, Sola which is a tertiary care hospital in Ahmedabad for a period of 1 year and included 100 patients with head and neck swelling. Detail clinical history and significant findings were noted.
After examination of swelling, explanation of procedure and informed consent of patient was taken. The swelling was fixed and aspiration of lymph nodes was done under aseptic precautions using 22 to 23 Gauge needle and 10 mL syringe. Both aspiration and non-aspiration techniques were used wherever required. Following the aspiration, the adequacy and nature of the aspirated material was assessed and several smears were prepared.
Smears were immediately fixed by air drying and in 100% alcohol, followed by four different stains including Giemsa stain, Hematoxylin–Eosin stain, Ziehl‑Neelsen stain, and Papanicolaou stain.
Lymph node biopsies were received in 100 patients and the biopsy specimens were subjected to histopathological examination after fixing in 10% formalin. Histopathological examination was done and the results were correlated with the cytological reports to evaluate efficacy of the procedure.
The results of the lymph node were divided in the following diagnostic categories: reactive lymphadenitis, tuberculous lymphadenitis, lymphomas, and metastatic deposits.
The reactive hyperplasia of lymph node was suspected by observing mixed lymphoid tissue and macrophages with tangible bodies along with absence of Reed Sternberg cells.
Granulomatous lesions were recognized cytologically by the observation of aggregates of epithelioid cells with, and without, associated multinucleated giant cells.
An amorphous necrotic background suggestive of caseative necrosis points to the diagnosis of tuberculosis. If TB suspected slides were stained with Ziehl–Neelsen method to detect acid fast bacilli (AFB) directly.
The diagnosis of lymphoma was suspected by monotonous lymphoid population with necrosis and mitoses.
The cytological diagnosis was correlated with histopathological examination of specimen submitted.
Metastatic carcinoma was diagnosed cytologically by presence of dual population composed of malignant epithelial cells and mixed lymphoid tissue.
| Results|| |
Out of 100 patients, 56 were males and 44 were females. Maximum numbers of cases (28%) were in the age group of 11 to 20 years. Age and gender wise distribution of the cases are shown in [Table 1].
Most common diagnosis in cytological and histological study was tuberculous lymphadenopathy (28%) [Figure 1] followed by reactive lymphadenopathy (14–16%), granulomatous lymphadenitis (12–14%) [Figure 2] and [Figure 3], malignant (7%) [Figure 4] as shown in [Table 2] and [Table 3].
|Figure 1 Acid fast Bacilli seen in histopathological section of Tuberculous lymphadenitis with Zn stain.|
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|Figure 4 Nodular sclerosis (Hodgkin lymphoma) (popcorn cell shown by red arrow).|
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|Table 3 Details of lesions on histopathological examination of lymph node|
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On correlation of FNAC findings with histopathology, overall correlation rate was 85.2% as shown in [Table 4].
|Table 4 Correlation between cytological and histopathological diagnosis of lymph node lesions|
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Most of the cases in our study were benign which was similar to data mentioned by Vimal et al.1 and Mohammed Abdul et al. as shown in [Table 5].
| Discussion|| |
The recent trend in medical practice is toward adopting a diagnostic modality, which is both cost effective and minimally invasive. In this regard, FNAC is often used as a first line of investigation for screening cases with lymphadenopathy, since this method is easy to perform, rapid, and inexpensive. FNAC can help not only to differentiate among lymphoma, and metastasis, but also to identify nonspecific reactive lymphadenitis and specific infections such as tuberculous lymphadenitis.
A total of 100 patients were included in our study who visited at tertiary care center. All of the 100 patients whose FNAC was done also underwent excisional biopsy.
The following measures are used to evaluate a screening:
Sensitivity = a/(a + c) × 100
Specificity = d/(b + d) × 100
Accuracy = a + d/(a + b + c + d) × 100.
Twenty eight cases, which were cytologically diagnosed as tuberculous lymphadenitis were also confirmed by histopathology. (True positive − 28). The sensitivity, specificity, and accuracy rates were 100%, 100%, and 100% respectively.
Out of 16 cases, which were diagnosed cytologically as reactive lymphadenitis, 14 cases turned out to be reactive process (true positive − 14) and two cases were turned out to be a Hodgkin Lymphoma. (False positive − 2.) The sensitivity of FNAC in diagnosing reactive lymphadenitis was found to be 100%. Hence, specificity for this lesion is 97.67% and accuracy was 98%.
Only seven cases were diagnosed cytologically as Hodgkin Lymphoma, and all the three cases were confirmed histopathologically also (true positive − 7). However, two cases which were diagnosed histopathologically as Hodgkin was diagnosed cytologically as reactive lymphadenitis (false negative − 2). Hence, the sensitivity of FNAC in Hodgkin Lymphoma was 77.78%, whereas specificity was 100% and accuracy was 98%.
13 cases turned out to be non-specific lymphadenitis in histopathology (true positive − 08) and five cases were turned out to be as follows: one case rosai Dorfman disease, one case cat scratch disease, two cases of granulomatous lymphadenitis, and one case of necrotizing lymphadenitis. (False positive − 5) The sensitivity of FNAC in diagnosing non-specific lymphadenitis was found to be 61.54%. Hence, specificity for this lesion is 100% and accuracy was 95% [Table 6],[Table 7],[Table 8].
|Table 6 Details of sensitivity, specificity and accuracy of lymph node lesions|
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|Table 7 Comparison of diagnostic accuracy of individual lesions with other study|
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|Table 8 Comparative study of percentage of cases, sensitivity, specificity, and accuracy observed in various studies on lymph node lesions|
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| Conclusions|| |
The results are quite encouraging and FNAC is recommended as the initial diagnostic test in the evaluation of superficial lymphadenopathy and is satisfactory tool in the diagnosis of tubercular and malignant lymphadenopathy.
It is most suitable for use on outpatient basis even in peripheral hospitals and dispensaries as it is quick, safe, minimally invasive, reliable, cost effective, and readily acceptable by patient.
The limitation of the procedure should be kept in mind and excision biopsy should be used whenever required.
FNAC is to be used in conjunction with clinical findings, radiological and laboratory investigations.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]