Diagnostic Utility of Proposed Sydney System of Lymph Node By Fine Needle Aspiration Cytology: A Cross-sectional Study

Abstract

Introduction: Fine needle aspiration cytology is the basic and simple technique for diagnosis and evaluation of lymphadenopathies. Although large numbers of conditions and cytomorphological overlapping may cause a challenging task in diagnosis. In 2020, an expert panel proposed the Sydney system for classification and reporting of lymph node based on cytology. Aim: To evaluate the diagnostic utility of the recently proposed Sydney system of reporting for lymph node aspirations. Material and Methods: This retrospective cross-sectional study was conducted at M. P. Shah Goverment Medical College, Jamnagar, Gujrat, India, from January 2020 to January 2022. Total of 194fine needle aspirations (FNA) of lymph node lesions performed were reviewed and cytologically reevaluated and classified according to the Sydney system and were compared with its clinical and histopathological details. The statistical analysis was done with the help Statistical Package for Social Sciences (SPSS) version 26.0. Results: Out of 194 FNA, 4.12%(n=8) were inconclusive, 61.34% (n=119) benign, 3.09% (n=6) atypical lymphocytic lesions, 13.4% (n=26) suspicious for malignancy and 18.04% (n=35) were malignant including metastasis and lymphomas. Data of 82 cases of histopathological follow-up was available. The sensitivity was 95.2% and the specificity was 94.1 %. The positive and negative predictive values were 98.3% and 84.21% respectively. The Risk of Malignancy (ROM) in category L2 was 0.5%, in category L3 was 50% and in category L4 and L5 were 100%. Conclusion: The proposed Sydney system for reporting lymph node cytology would be helpful in the improvement of quality of reports, better understanding and communication between clinician and pathologist and thereby improving patient care.