The Analytical Feasibility of Sydney System in Reporting Lymph Node Cytology in a Tertiary Care Hospital

Abstract

Introduction: FNAC is the first diagnostic step in patients with lymphadenopathy because of its simplicity and minimal invasive nature which helps to confirm the clinical suspicion. A definite specific diagnosis may not be possible in few cases but a categorisation of the disease and differential diagnosis can help to suggest the most efficient further investigations, saving time and resources.

Aim: The aim of this study is to ascertain the system’s applicability and precision in the diagnosis of lymph node cytology.

Methodology: This is a retrospective cross sectional study of lymph node cytology conducted from January 2023 to June 2023 and the results were reported using the Sydney System into 5 groups from L1 to L5. For accuracy, the cytological diagnoses were compared with corresponding histological diagnoses and also with specific clinical findings that warranted FNA. The statistical tools used were calculation of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and risk of malignancy (ROM).

Results: 60 cases were evaluated by FNAC. Out of this 43 were benign cases which comprised of 16 cases of Reactive lymphadenitis, 22 cases of Granulomatous/Tuberculous lymphadenitis and 4 cases were of Acute suppurative lymphadenitis and 1 case of only Caseous necrosis. Out of 17 malignant cases, 1 case was of Non Hodgkins lymphoma, 2 cases were of Hodgkins lymphoma and 14 cases were of metastatic carcinoma.

Conclusion: The Sydney system was used for clinicopathological diagnosis of patients presenting with lymphadenopathy and was found to be a reliable tool for evaluation of risk of malignancy and its subsequent management of the patient.