Assessment of disease pattern of lymphadenopathy among patients presenting to Rural tertiary care teaching hospital of western Maharashtra

Abstract

Background:Lymph nodes are widely distributed and easily accessible lymphoid tissue, which are frequently examined for diagnostic purposes. In the past lymph nodes were the first organs to be sampled by FNA. FNAC is useful before an open biopsy where the patients present with multiple lymph node enlargements. The study intends to find out systematically the various pathological conditions presenting with enlarged lymph nodes and cytomorphological appearance of these conditions in tertiary rural hospital in western Maharashtra.Materials & methods:A total of 247 patients were included in present study. These patients were clinically evaluated and informed consent was obtained for the procedure. Lymph node to be aspirated was first examined thoroughly to determine the site of aspiration. Under aseptic precautions the node was held between the left index finger and thumb, followed by insertion of a 22 or 23 gauge needle fitted to a 10 ml syringe for routine lymph node aspiration. Two smears were immediately fixed in 95% ethyl alcohol and two were air dried. Alcohol fixed and air dried smears were stained with Papanicolaou stain and May-Grunwald-Giemsa stain respectively. Ziehl-Neelsen stain was done for all the cases where necrotic material was aspirated or clinically suspected tuberculosis and HIV. Data regarding relevant radiological, biochemical and haematological investigations done for diagnostic purposes were collected.Histopathological study was done separately and then results of cytological and histopathological study were correlated to evaluate efficacy of the procedure.Results:Age of the patient varied between 1.5 years to 85years. Out of 223 satisfactory smears, 118(47.8 %) constituted benign lesions, 92cases (37.2%) were of metastasis and 13(5.3%) cases were of lymphoma. Out of total non-neoplastic lesion, reactive hyperplasia was seen in 52.5% of cases whereas tubercular lymphadenitis constitutes 22.9% cases. Metastatic squamous cell carcinoma commonly involved the submandibular and cervical groups. While, the axillary and supraclavicular nodes showed involvement by metastatic deposits of infiltrating ductal carcinoma in maximum cases. Children and adolescents were commonly involved by chronic nonspecific reactive hyperplasia while metastatic squamous cell carcinoma was seen affecting elderly and older individuals. Conclusion:FNAC is a simple, rapid & accurate diagnostic technique in evaluation of lymphadenopathies. It helps the clinicians to take early decision for management and avoid unnecessary surgery.