Utility of fine needle aspiration cytology in evaluation of lymphadenopathy - an audit from a Cancer Centre in South India

Background: Cytological evaluation and diagnosis of lymphadenopathy plays an important role in distinction between reactive hyperplasia and malignancy. Being a tertiary cancer care centre, lymph node enlargement clinically suspected to be due to malignancy constitute the commonest indication for fine needle aspiration cytology [FNAC] at our centre. The aim of this study was to determine the utility of FNAC in evaluating enlarged lymph nodes and to categorizethe causes of lymphadenopathy diagnosed by FNAC at our centre

Material and Methods: Data was collected from the records of department of Pathology over a period of three months from January to March 2014. The data was analyzed and various parameters studied

Results: There were 2000 aspirates over a period of three months of which 270 [13.5%] were from lymph nodes. Of these, 130cases [48.2%] have metastatic deposits.We also came across 16 cases [5.9%] of lymphoma, 5 cases[1.9%] of granulomatous lymphadenitis, 2 cases[0.7%] of suppurative lesion and 99 cases [36.7%] of reactive hyperplasia during this period. In 3 cases [1.1%], the lesion turned out to be of salivary gland origin. Aspirates were suboptimal for diagnosis in 15 cases [5.5%]. Aspirates were more in males [181] as compared to females [89]. The most common site of aspiration was the cervical lymph node[64.5%],followed by supraclavicular=81[30%], inguinal=33[12.22%], axillary=19[7.04%] sub mental=1[0.37%] and others=7[2.59%]. Apart from metastatic carcinomas other metastatic malignancies we came across were malignant melanoma, neuroblastoma, germ cell tumor and synovial sarcoma

Conclusion: FNAC of lymph nodes helps in rapid diagnosis of lymphadenopathy. Categorizing the cause of lymph node enlargement as metastatic malignancy,lymphoma, reactive change, inflammatory cause,suppuration etc. can be done by FNAC.In patients with known histologically proven malignancy in whom a subsequent enlargement of lymph node occurs,a cytological diagnosis of metastasis helps in avoiding unwanted surgery for confirming metastasis.In patients without a previous diagnosis of malignancy, FNAC not only confirm metastatic deposit but in most conditions give a clue regarding site of primary. The use of immunocytochemistry and cell block preparations have increased the scope of FNAC

Role of lymphadenectomy and its impact on survival in endometrial carcinoma - an institutional experience

Pelvic and para aortic lymph nodes are the common sites of metastasis in endometrial carcinoma. The role of lymphadenectomy is widely discussed in literature with varying results. In this study we did a retrospective analysis of endometrial cancer patients to correlate lymphadenectomy with overall and disease free survival. A retrospective review of 110 patients with carcinoma endometrium who underwent staging laparotomy at our institute during the period 2006-2010. Patients who underwent node dissections were categorized as group I and the rest as group II. Median lymph node count was 10. Grade of the tumor, nodal status and lymphadenectomy were correlated with overall and disease free survival. Lymph node metastasis and grade of tumor are significant predictors of survival. Lymphadenectomy did not show significant survival benefit. It has helped to upstage the disease so that appropriate adjuvant therapy could be planned. A prospective randomized control trial with complete pelvic and para aortic node dissection and uniform adjuvant therapy considering nodal status may help to answer the confusion regarding lymphadenectomy