Effectiveness of fine needle aspiration cytology versus excisional biopsy in cervical lymphadenopathy

Abstract

Background: Cervical lymphadenopathy is a common cause of referral to the surgery department. In low-resource countries, fine-needle aspiration cytology (FNAC) has been advocated as an alternative to more expensive surgical excision biopsies. Although FNAC is a simple and effective procedure in many conditions, its sensitivity and specificity still remains a question. The primary aim of our study was to evaluate the sensitivity and specificity of FNAC of head-and-neck lymph nodes using histopathology as the gold standard. Methods: All patients clinically diagnosed with cervical lymphadenopathy were included in the study, and they underwent FNAC followed by surgical excision and histopathology. The results were tabulated and analyzed using IBM SPSS V.20.0 software. To test the statistical significance between benign and malignant groups, Chi-square test was used, and the difference in FNAC and histopathology were analyzed using McNemar s test. Results: The mean age group in our study of 86 patients was 45.20 ± 18.20 years with equal sex distribution. Among 23 male patients with age above 45 years, 15 patients (65.2%) had malignancy in the lymph node. Level V lymph nodes were most commonly involved (n = 31 [36%]), of which 13 were diagnosed as malignancy and 10 as tuberculosis (TB). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value of FNAC in comparison to histopathology for diagnosis of malignancy were found to be 79.4%, 98.1%, 96.4%, and 87.9%, respectively, and for TB was 77.8%, 87.5%, 87.5%, and 77.8%, respectively. Conclusion: FNAC of head-and-neck lymph nodes has comparable sensitivity and specificity with histopathological examination. It has a very high (96.4%) PPV in detecting malignancy and 100% for detecting metastatic disease in cervical lymph nodes. In patients with suspected lymphoproliferative disorder and in patients above 45 years of age, open biopsy is recommended. For younger patients and in level V cervical lymphadenopathy, irrespective of age, FNAC should be the first invasive diagnostic tool of choice.