Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Cancer Cytopathol. 2021 Sep;129(9):701-718. doi: 10.1002/cncy.22432. Epub 2021 Apr 8.
Fine-needle aspiration cytology (FNAC) is one of the most commonly used techniques for evaluating lymphadenopathy. Recently, the Sydney system was proposed for assessing the performance, classification, and reporting of lymph node (LN) cytopathology. The present study was conducted to assess the risk of malignancy associated with each of the diagnostic categories of the proposed Sydney system.
This was a 2-year retrospective study of LN-FNAs; cytologic diagnoses were categorized by the proposed Sydney system. Cytological diagnoses were correlated with the corresponding histopathological diagnoses to assess diagnostic accuracy and risk of malignancy for each diagnostic category.
Of 23,335 FNAs during the study period, 6983 (30%) were performed on LNs. Of these, 289 (4.1%) cases were reported as nondiagnostic/inadequate (L1); 3397 (48.6%) were reported as benign (L2); 33(0.5%) as atypical cells of undetermined significance (L3), 96 (1.4%) as suspicious for malignancy (L4) and 3168 (45.4%) as malignant (L5). Subsequent histopathology was available for 618 (8.8%) cases. On cytohistopathologic correlation, 552 (89.3%) were concordant and 66 (10.7%) discordant. The overall sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of LN-FNA were 79.9%, 98.7%, 98.4%, 83.1%, and 89.3%, respectively. The risk of malignancy was 27.5% for the nondiagnostic category, 11.5% for the benign, 66.7% for the atypical, 88% for the suspicious, and 99.6% for the malignant categories.
FNAC has high diagnostic accuracy for the diagnosis of various LN pathologies. Application of the proposed Sydney system can help in achieving uniformity and reproducibility in cytologic diagnoses and also help in risk-stratification on cytology.
细针穿刺细胞学检查（FNAC）是评估淋巴结疾病最常用的技术之一。最近，悉尼系统被提出用于评估淋巴结（LN）细胞学病理的性能、分类和报告。本研究旨在评估拟议的悉尼系统的每个诊断类别与恶性肿瘤风险的相关性。
这是一项为期 2 年的 LN-FNAC 回顾性研究；细胞学诊断通过拟议的悉尼系统进行分类。将细胞学诊断与相应的组织病理学诊断进行比较，以评估每个诊断类别的诊断准确性和恶性肿瘤风险。
在研究期间，23335 例 FNAs 中有 6983 例（30%）是对 LNs 进行的。其中，289 例（4.1%）报告为非诊断/不足（L1）；3397 例（48.6%）报告为良性（L2）；33 例（0.5%）为意义未明的不典型细胞（L3），96 例（1.4%）为可疑恶性（L4），3168 例（45.4%）为恶性（L5）。随后的组织病理学检查可用于 618 例（8.8%）病例。在细胞病理相关性方面，552 例（89.3%）是一致的，66 例（10.7%）是不一致的。LN-FNA 的总敏感性、特异性、阳性和阴性预测值以及诊断准确性分别为 79.9%、98.7%、98.4%、83.1%和 89.3%。诊断为非诊断性的恶性肿瘤风险为 27.5%，良性的为 11.5%，不典型的为 66.7%，可疑的为 88%，恶性的为 99.6%。
FNAC 对各种 LN 病理的诊断具有很高的准确性。应用拟议的悉尼系统有助于在细胞学诊断中实现一致性和可重复性，并有助于在细胞学上进行风险分层。
