Diagnostic Efficacy of Sydney System of Classification of Lymph Node Cytology with its Histopathological Correlation in the Diagnosis of Lymph Node Malignancy and Assessement of Risk of Malignancy.
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Abstract
Background:Fine needle aspiration cytology(FNAC) has proved to be one of the minimally invasive, rapidand cost-effective method in the diagnosis of all kind of lymph node(LN)lesions. The Sydney system of cytological classification of LN- FNACs was proposed to bring uniformity in reporting LN cytology.The present study aims at reclassifying LN-FNACs according to the Sydney system, assessing its diagnostic accuracy and calculating the risk of malignancy (ROM) associated with each of the diagnostic categories with histopathological correlation.Results: This is 3year retrospective study carried out between July 2020 to June 2023 at a tertiary care hospital. A total of 660 patients between 5 to 75 years of age were included.Male to female ratio was 2:1. Commonest group of LN involved was cervical group. According to Sydney system LN cytology cases were categorized into L1: inadequate/nondiagnostic (46), L2: benign (296), L3: atypical cells of undetermined significance/atypical lymphoid cells of uncertain significance (50), L4: suspicious (104) and L5: malignant (164). HP correlation was obtained in 484 cases.Risk of malignancy for various categories were50%,12.5%,71.42%,95.83% and 100% respectively. The overall sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of LN-FNA were98.73%,90.5%, 90.12%,97.14% and 99.17% respectively. Conclusion:The application of the newly proposed Sydney system for reporting LN cytopathology produces uniformity in cytological diagnosis, improves the diagnostic accuracy and helps in risk stratification.