Evaluation of etiology of lymphadenopathy in different age groups using Fine Needle Aspiration Cytology: A retrospective study

摘要

Background: Lymphadenopathy is a common presenting symptom in various diseases. Lymph nodes react to various stimuli and undergo changes leading on to vast array of neoplastic or non-neoplastic proliferations.1 FNAC is a simple, quick and inexpensive method that is used to sample superficial masses and is now considered a valuable diagnostic aid.1,2,3 Objective: The present study was undertaken to evaluate the usefulness of FNAC as a diagnostic tool in cases of lymphadenopathy, to find the frequency and cause of lymph node enlargement in patients of different age groups and analyze the different cytomorphological patterns associated with various lymphadenopathies.Settings and design: Retrospective study conducted in the Department of Pathology, Subharti Medical College, Meerut from July 2006 to June 2009 (3years).Material and Methods: Total 1350 patients of lymphadenopathy who underwent FNAC were divided into 3 groups: Group I including pediatric patients (i.e. 0-15 years), Group II including adolescent and middle aged patients (i.e. 16-45 years) and Group III with elderly patients (i.e. >45 years).Observation: Maximum number of patients with lymphadenopathy was in Group II with 640 patients (47.4%), followed by Group I: 498 patients (36.89%) and Group III: 212 patients (15.7%). Commonest causes of lymphadenopathy in different groups were found to be: In Group I- reactive hyperplasia 353(70.88%), Group II- Tubercular lymphadenitis 261(40.78%) and Group III- Metastatic carcinoma 115(54.25%).Conclusion: It was concluded that different etiological factors play role in causation of lymphadenopathy in different age groups and that aspiration cytology provided a reliable, safe, rapid and economical method of screening these patients with accuracy. Work Attributed To –Department Of Pathology, Subharti Medical College, Meerut ,U.P., India. Financial Support- Subharti Medical College, Meerut, U.P., INDIA. Introduction Aspiration of lymph nodes for diagnostic purpose was reported as early as 1904 by Grieg and Gray who used this procedure in the diagnosis of trypanosomiasis.3,4 In 1921, Guthrie attempted to correlate lymph node aspiration cytology with various disease processes.3,5 FNAC is particularly helpful in the work-up of cervical masses and nodules because biopsy of cervical adenopathy should be avoided unless all other diagnostic modalities have failed to establish a diagnosis.3,6 FNAC is nowadays recognized as a rapid diagnostic technique because of its simplicity, early availability of results, minimal trauma and absence of complications.7,8 The aim of this study was: 1) To evaluate the role of FNAC in patients presenting with lymph node enlargement 2) To find out the frequency of lymphadenopathy in different age groups 3) To find out the etiological factors causing lymphadenopathy in different age groups 4) To study the different cytomorphological patterns associated with various lymphadenopathies. Materials and Method The present study on 1350 patients of lymphadenopathy was conducted in the Department of Pathology, Subharti Medical College, Meerut over a period of 3 years from July 2006 to June 2009. FNAC of the enlarged lymph nodes was performed with informed consent of the patient. Detailed history was noted. Palpable nodes were aspirated in the cytology department while guided FNAC (USG, CT) was performed in deep seated ones. Procedure was done using a 23-25 G needle and 10ml syringe with the help of Franzen handle where required. Smears were stained with Geimsa, Hematoxylin and Eosin (H&E) and Pap stains depending upon the clinical presentation of the patient. In elderly patients more smears (atleast 50%) were fixed in alcohol and stained with Pap and H&E stains. In all cases where there was strong clinical or cytological suspicion of tuberculosis, Ziehl-Neelsen staining was performed to see the presence of acid fast bacilli. The smears prepared were studied to arrive at a probable diagnosis. Observations A total of 1350