Reliability and limitations of fine needle aspiration cytology of lymphadenopathies. An analysis of 1,261 cases.

In a study spanning over two years, 1,261 cases with clinically significant lymphadenopathies were subjected to fine needle aspiration cytology (FNAC) to evaluate the reliability and limitations of the procedure. In the first phase of the study, consisting of 100 cases, the cytologic diagnosis was compared with histopathology, and the results were analyzed with a view to standardizing the procedure. In the second phase of the study, consisting of 1,161 patients, FNAC was used as the primary modality of diagnosis. Excision biopsy was done only when there was a clinical-cytologic discrepancy, failure to respond to treatment or FNAC diagnosis of non-Hodgkin's lymphoma. The highest diagnostic accuracy with FNAC was observed in metastatic carcinoma. Though tuberculous lymphadenitis, reactive hyperplasia and lymphoma were diagnosed with almost similar accuracy, reactive hyperplasia and non-Hodgkin's lymphoma proved difficult to diagnose. Although FNAC has proven to be a simple, safe, reliable and cost-effective diagnostic tool for lymphadenopathies, the limitations of the procedure should be kept in mind and excision biopsy used whenever required.