Cytologic Evaluation of the Enlarged Neck Node: FNAC Utility in Metastatic Neck Disease

摘要

Introduction: Fine Needle Aspiration Cytology not only confirms the presence of metastatic disease, but also gives clues regarding the nature and origin of the primary tumour. Study Design: The study material comprised of all aspirates (1978 aspirates from 1255 patients) from the neck lymph nodes during the period January 2003 to December 2003. All hematolymphoid neoplasms were excluded. The FNA results were reviewed, the morphology of the individual cells and their patterns in the smears were studied in detail and the FNA diagnosis was correlated with the histology.Results: Cytology results were unsatisfactory in 184 specimens (9%), negative or reactive in 495 specimens (25%) and suspicious or positive for malignancy in 1299 specimens (65.67%). The most common metastasis to the neck nodes was of squamous carcinoma arising in the oral cavity.Conclusion: FNA of head and neck masses proved to be a useful tool in diagnosing metastasis with good certainty. Introduction A neck mass in an adult, that is present for longer than a week is pathological until proven otherwise.1 In our country, tubercular lymphadenitis is not at all uncommon but even so, a large percentage of all persistent adult neck masses turn out to be malignant, whereas in the pediatric population neck masses are only rarely malignant.The use of Fine Needle Aspiration Cytology (FNAC) for the diagnosis of metastatic malignancies in the lymph nodes is a well-established method.2 Lymphadenopathy may be the first sign of malignancy in a patient. FNAC not only confirms the presence of metastatic disease, but also gives clues regarding the nature and origin of the primary tumour. In patients with enlarged lymph nodes and previously documented malignancy, FNAC can obviate further surgery performed merely to confirm the presence of metastasis. However, regional lymphadenopathy is not always due to metastatic tumour, and not every nodule represents a lymph node. Cysts (congenital or acquired), abscesses, subcutaneous benign and malignant tumours may also raise the question of lymph node metastasis, especially in patients with a known tumour.3 The false- positive rate of lymph node FNAC for the detection of metastasis is quite low (in the range of 0.9-1.7%). 2 Avoiding false-positive diagnosis is of obvious importance since therapeutic and surgical decisions are often based exclusively on cytology results. Cystic metastasis and aspirates of unusual low grade malignancies compose most of the false-negative cases.3,4,5 Moreover; the procedure is very cost effective, simple, and free of complications, well tolerated by the patient, done on an outpatient basis and repeatable. India is imminently suited to use this procedure, & this is borne out by the fact that it has flourished both in large institutions, in peripheral small community hospitals & in private clinics. Increased exposure and routine audits have improved the sensitivity and the accuracy of FNAC in all anatomic sites, particularly so in head and neck masses.6,7,8 The present study will address metastatic lesions occurring in the adult population. These are generally metastatic from the upper aero digestive tract and salivary glands or may present as occult primaries. Occasionally a neck metastasis from a distant site springs from the gastrointestinal tract, kidney or the lung. Other primary sites below the clavicle, which may appear in the neck, are the cervix, ovary and sometimes even the bladder. Material And Methods The study material comprised aspirates from the neck lymph nodes during the period January 2003 to December 2003 (12 months). All hematolymphoid neoplasms were excluded. This made up a total of 1978 aspirates from 1255 patients. In the design of the present study, each aspirate was considered as one case.FNAC was performed using a 23-gauge needle. An average of 2 passes was performed and minimum 3 slides were prepared. One slide was air dried and stained by Giemsa stain, while the remaining 2 slides we