Cervical Group Of Lymph Nodes Research Articles

Utility of the Proposed Sydney System for Classification of Fine-Needle Aspiration Cytopathology of Lymph Node: A Retrospective Study at a Tertiary Care Center

Introduction: Fine-needle aspiration cytology (FNAC) is an established first-line technique for the evaluation of lymphadenopathy and, with the help of ancillary testing, can in many instances obviate the need for an open biopsy. The Sydney system was recently proposed to provide consensus guidelines for the performance, classification, and reporting of lymph node FNAC. The present study was undertaken to evaluate its utility and study the impact of rapid on-site evaluation (ROSE). Material and Methods: A retrospective analysis in which 1,500 lymph node FNACs was reviewed and assigned a diagnostic category from the Sydney system. Cyto-histopathological correlation and adequacy parameters were evaluated. Observation and Results: The cervical group of lymph nodes was the commonest group aspirated (89.7%). A total of 1,205/1,500 (80.3%) cases were category II (benign), and necrotizing granulomatous lymphadenitis was the most common pathology. The 750 cases with ROSE were subclassified as follows: 15 category I (inadequate), 629 category II (benign), 2 category III (atypia of undetermined significance), 9 category IV (suspicious for malignancy), and 95 category V (malignant). Among 750 cases without ROSE, 75 cases were in category I, 576 in category II, 3 in category III, 6 in category IV, and 90 in category V. Category I was thus significantly lower in the ROSE group compared to the non-ROSE group. Overall, the risk of malignancy was L1-0%, L2-0.20%, L3-100%, L4-92.3%, and L5-100%. Accuracy parameters revealed a sensitivity of 97.7%, specificity of 100%, PPV of 100%, NPV of 99.10%, and diagnostic accuracy of 99.54%. Discussion and Conclusion: FNAC can be used as the 1st line of treatment for lymph node pathology. ROSE can be used as an add-on to FNAC for reducing unsatisfactory rates and help triage material for ancillary testing whenever possible. The Sydney system should be implemented for achieving uniformity and reproducibility.

A comparative study of the role of cytopathology, staining for acid-fast bacilli and genexpert MTB/RIF assay in the diagnosis of tubercular lymphadenopathy

The diagnosis of tubercular lymphadenopathy can be made by FNAC combined with staining for AFB along with newer methods like GeneXpert assay. India carries one of the largest burdens of TB accounting for twenty-seven per cent of worldwide cases. To evaluate the role of cytopathology, AFB staining and GeneXpert assay in the rapid diagnosis of tubercular lymphadenopathy along with the usefulness of GeneXpert assay in the diagnosis of indeterminate aspirates. A total of 372 patients presenting with lymphadenopathy and clinical suspicion of a tubercular aetiology were included in the analysis.183 patients (56%) were adults (20-59 years) followed by 66 patients (20%)in the paediatric age group. 189 were females(57.3%) and 141 were males (42.7%). The cervical group of lymph nodes were most commonly involved (66%).69.1% were AFB positive in 201 smears with features favouring tubercular infection (positive cytology) which increased to 183 (91%) when GeneXpert Analysis was done, while 72 cases (55.8%) were AFB positive on cases with indeterminate cytology which showed an increment to 108 cases (83.7%) on the application of GeneXpert. FNAC combined with ZN staining and GeneXpert has a much higher diagnostic accuracy, GeneXpert further prevents underdiagnosis and enables rapid and accurate diagnosis in cases with indeterminate/inconclusive FNAC and ZN staining.

Assessment of Utility of Fine Needle Aspiration Cytology in Patients of Peripheral Lymphadenopathy- Experience of A Tertiary Care Hospital

Background: Fine needle aspiration cytology (FNAC) is a quick, sensitive, safe, reliable and cost-effective outdoor procedure that has a lower risk of complications as compared to a surgical biopsy. This study was conducted to analyse the various cytomorphological patterns establishing the diagnosis on FNAC in peripheral lymphadenopathy patients along with their clinical presentation.Methods: This study included 300 patients of peripheral lymphadenopathy in a tertiary care hospital of north-central Haryana. FNAC was done under all aseptic conditions and various cytomorphological patterns were analysed.Result: On stratification of lymph node lesions, 240/300 cases (80%) were reported as non-neoplastic and 60/300 cases (20%) as neoplastic lesions. Among the non-neoplastic lesions, granulomatous pathology was the commonest lesion encountered in 137/240 cases (57.1%), followed by reactive lymphoid hyperplasia and suppurative lymphadenitis. Metastatic involvement of lymph node was the commonest pathological finding diagnosed in 52/60 of malignant neoplastic cases (86.66%). Overall, the cervical lymph nodes were most commonly involved in 68.66% patients, followed by other lymph nodes.Conclusion: Lymphadenopathy can have varied etiologies ranging from non-neoplastic to neoplastic conditions. FNAC as a first line investigative procedure in lymphadenopathy patients obviates the need for surgical excision and guides subsequent patient therapy and management. The cervical group of lymph nodes are most commonly involved in both non neoplastic as well as neoplastic lymph node lesions. In younger age group (<30 years) non neoplastic causes of lymphadenopathy are more common whereas in elderly the malignant neoplastic causes are more common. The secondary metastatic carcinoma is more common than primary lymphoma of the lymph nodes. 

English

BACKGROUND Lymph nodes (LN) are an integral component of the immune system. Enlarged lymph nodes are a prime target for fine needle aspiration (FNA). Lymph nodes greater than 1 to 2 cm are an immediate source of concern. Lymphadenopathy is a common presenting symptom in various diseases. Fine needle aspiration cytology (FNAC) confirms the presence of metastatic disease and gives a clue regarding its nature and origin of primary malignancy. In many metastatic malignancies, FNAC may be the only tool for diagnosis and further management of the patients. We intend to assess the cytomorphological patterns of both primary tumour and metastatic tumour in a lymph node. METHODS A retrospective study was conducted in the Department of Pathology, RIMS, Imphal, over a period of one year from January 1, 2018 to December 31, 2018. Five hundred and fifty-five lymph nodes were aspirated, out of which 99 cases turned out to be malignant lesions. Giemsa and PAP stained FNAC slides were collected and reviewed. Data entry and analysis were done by using SPSS version 21. RESULTS Out of 99 cases, 88.9 % were metastatic tumours and 11.1 % were of primary lymphoproliferative disorders. Thirty three percent of malignant lymphadenopathy were found in fifth decade. Undifferentiated carcinoma constituted around 32.3 % of all the cases of malignant lymphadenopathy. Cervical group of lymph nodes were involved in 46.5 % of cases. CONCLUSIONS FNAC has proved to be a useful tool in diagnosing malignancy with good certainty. FNAC of lymph nodes prevents complications associated with lymph node biopsy. KEYWORDS FNAC, Lymph Node, Undifferentiated Carcinoma, Squamous Cell Carcinoma

FNAC SPECTRUM OF LYMPHADENOPATHY IN A TERTIARY CARE HOSPITAL

Background – The aim of this study was to identify the pattern of pathologies on FNA of supercial lymph nodes in a tertiary hospital over a period of one year. Methods – The data pertaining to our reports given to the patients who underwent FNAC evaluation of supercial lymph nodes was analysed to determine age distribution of patients, group of lymph nodes involved and distribution of pathologies diagnosed . Results – Majority of patients were adults. Cervical group of lymph nodes were most commonly involved. Granulomatous lymphadenitis was the predominant diagnosis in our series 39%. Conclusion – Fine needle aspiration evaluation is a quick, easy, relatively non traumatic and in expert hands, a reliable method of diagnosing the pathology of underlying enlarged supercial lymph nodes. Granulomatous lymphadenitis was the most common causes of lymph node enlargement in our series.

Normal head and neck lymph nodes in the paediatric population

To determine the normal range of head and neck lymph nodes in a paediatric population. A retrospective review was undertaken of 200 brain magnetic resonance imaging (MRI) examinations in patients aged between 5 months to 16 years. Exclusion criteria included possible causes for lymphadenopathy. Studies were reported previously as normal. Eight regions were assessed for the presence of nodes, short and long axis of the largest node measured, and the ratio was calculated. Most commonly identifiable nodes were the deep cervical, submandibular, and posterior cervical in 100%, 99.5%, and 92.5% of studies. In the long axis, the three largest were the submandibular, deep, and posterior cervical with mean values of 19.7, 18.1, and 15.4 mm, respectively. For the S/L ratio, the three with the most oval shape were the pre-auricular, occipital, and submental with ratios of 0.64, 0.63, and 0.6, respectively. A positive correlation between the occipital and deep cervical lymph node groups with age was found to be stronger than the rest of localisations. This study characterises the normal distribution, size, and shape of head and neck lymph nodes in a healthy paediatric population, demonstrating that rounder and larger lymph nodes may be a normal finding, depending on their location and patient age.

A clinicopathological study of cervical lymphadenopathy – A hospital-based cross-sectional study

Introduction: The enlargement of lymph nodes is an index of spread of infection and malignancy. Fine-needle aspiration cytology (FNAC) has the ability to provide rapid diagnosis and has good economic saving, reduces patient anxiety, and can be used for patients who have anesthetic risks. Aims and Objectives: The aim of the study is to study the various clinical presentations of cervical lymphadenopathy. Materials and Methods: This study was conducted from June 2019 to August 2020 over a period of 14 months. The study consists of 100 consecutive cases, both outpatients and inpatients at the surgical outpatient/wards at Malla Reddy Institute of Medical Sciences, Hyderabad. In all cases, FNAC was done. Excisional biopsy was done in all 100 cases. Results: The incidence of cervical lymphadenopathy was highest in the 12–40 years age group (73%). Males were more affected than females with a male-to-female ratio of 1.22:1. Tuberculosis was the most common etiology accounting for 51%. Posterior group of cervical lymph nodes were the most common to get involved in tuberculosis (31.3%). Sixteen cases out of 51 cases of tubercular lymphadenitis showed constitutional symptoms. The sensitivity of FNAC for tuberculosis – 86%, chronic nonspecific lymphadenitis – 73.3%, malignant secondaries – 87.5%, and lymphomas – 90%. Histopathological examination is the most dependable diagnostic tool. Conclusion: The most common disease affecting lymph nodes is tuberculosis. Dependence on clinical evidence alone would lead to erroneous diagnosis in most of the cases. FNAC is an important frontline investigation. Histopathological examination remains the most dependable diagnostic tool.

Spectrum of diseases presenting with lymphadenopathy in elderly: Fine needle aspiration cytology of 60 cases

Introduction: Lymphadenopathy is one of the common clinical presentations in patients of all age group. Lymphadenopathy can be due to reactive or infective cause, but malignancy including metastastic deposits in are not uncommon in elderly. Fine needle aspiration cytology (FNAC) is a useful diagnostic rapider in many mass lesions like lymphadenopathy. Aims and Objectives: Three years study was conducted to know the spectrum of diseases causing enlargement of lymph nodes in elderly patients with age 60 years and above. Materials and Methods: We have collected all the clinical data from the registers from June 2014 to June 2017 in Medical records section, KIMS, Koppal and reviewed FNAC slides of lymph node aspirates of elderly. Results: A total of 60 elderly patients of age 60 years and above with lymphadenopathy were included in this study. Cervical group of lymph nodes were the predominant site for lymphadenopathy. The commonest cause of lymphadenopathy was reactive, seen in 29 patients, followed by 23 patients with metastatic deposits and squamous cell differentiation was commonest type. Tubercular and suppurative lymphadenitis were observed in four cases each. CBNNAT is an useful diagnostic modality in microbiological confirmation of tuberculosis. Males showed preponderance of reactive as well as in metastatic lymphadenopathy. Conclusion: Though reactive lymphadenitis is the commonest cause for enlargement of lymph nodes but metastatic deposits are not uncommon in elderly. FNAC as a diagnostic rapider useful screening tool for all elderly patients presenting with lymphadenopathy. Keywords: Lymphadenopathy, Reactive, Metastatic, FNAC, Tubercular, CBNAAT.

Morphological patterns of FNAC of lymph nodes

Introduction: Fine needle aspiration cytology is fast becoming preoperative method of choice for diagnosis and management of various lumps and lesions since few decades. It helps clinician to decide mode of treatment in most cases in both non-neoplastic and neoplastic disorders. The aim of our study was to assess utility of FNAC in the diagnosis and management of lymph node disorders and distribution of these lesions according to different lymph node groups and age and sex distribution of these lesions. Materials and Methods: The present study was done during the period between December 2015 and May 2017 in the department of pathology (central clinical laboratory), Koppal Institute of medical sciences, Koppal. 10ml syringe and 23/24 gauge needles were used for the procedure. Material obtained was expressed on slide and smears were made by standard smearing technique. Both wet and air dried smears were made. Wet smears were stained with Haematoxylin and Eosin stain and dry smears with Lieshman stain and Giemsa stain. Ziehl-Neelson staining for acid fast bacilli was done wherever required. Results: We assessed 204 cases of lymphadenopathy cases. We got satisfactory aspirate in most (97.1%) cases. Cervical group of lymph nodes were most commonly (82%) involved. Granulomatous lesions were most common in young adults and reactive nonspecific lesions were most common in paediatric group. Metastatic carcinomas were most common type after 50yrs age group. Conclusion: Fine needle aspiration is simple, rapid and cost effective method to know the cause of lymphadenopathy. It significantly reduced unnecessary surgical biopsy for diagnosis of lymphadenopathies in our case. Keywords: FNAC, Lymph node, Morphology, Lymphadenopathy.

High rate of IIA/IIB neck groups involvement supports complete lateral neck dissection in thyroid carcinoma.

Although therapeutic lateral neck dissection (LND) may be indicated in thyroid carcinoma, the cervical lymph node groups IIA and IIB, according to Robbins classification, are often not removed. The aim of our study was to determine the relevance of complete comprehensive LND in thyroid carcinoma. We conducted a retrospective study between January 2011 and August 2018 in a university teaching hospital. Histopathological analysis of LND performed during total thyroidectomy in thyroid carcinoma was reviewed according to lymph node level. To demonstrate that neck dissection of upper groups, IIA/IIB, is necessary when therapeutic LND is indicated in thyroid carcinoma, we compared histopathological involvement in complete comprehensive LND of the upper groups IIA/IIB to the lower groups III/IV/V. A total of 30 LND (24 patients) were suitable for analysis. Analysis by neck side revealed that comprehensive LND dissection samples were negative in 3 cases, and positive in 27. In those 27 positive LND, 15 demonstrated involvement of the groups IIA/IIB, and 12 were positive for involvement of the III/IV/V groups only. The combined presence of positive IIA/IIB and positive III/IV/V was observed in 15 of the 27 neck sides. There was no positive IIA/IIB without positive involvement of III/IV/V groups. The high rate of positive cervical lymph nodes in the upper groups IIA/IIB supports complete comprehensive LND rather than selective III/IV/V LND in thyroid carcinoma surgery. However, impact on survival and whether postoperative radioactive iodine treatment may be modulated remain to be studied.

Added value of metastatic cervical lymph node group V in nodal staging of nasopharyngeal cancer.

Prognostic significance of posterior cervical lymph node metastasis in nasopharyngeal cancer is largely unknown. This study aims to determine the added prognostic significance of cervical lymph node group V to the standard American Joint Committee on Cancer (AJCC) staging system (eighth edition AJCC) of nasopharyngeal patients with cancer treated with intensity-modulated radiation therapy (IMRT) in terms of overall survival (OS), distant metastatic-free survival (DMFS), and disease-free survival (DFS). A retrospective cohort of 199 consecutively diagnosed nasopharyngeal patients with cancer treated with definitive radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) in the era of IMRT in a large university hospital in endemic area of Southeast Asia. Pre-treatment imaging studies were thoroughly re-evaluated and re-staged by a board-certified radiologist using radiographic criteria for cervical lymph node metastasis. T and N classifications were reclassified according to the eighth AJCC staging system. Group V (Va and Vb) cervical node was evaluated for its added prognostic significance. Cox's proportional hazard model was used to retrieve hazard ratio (HR), 95% confidence interval and P value for N classification. Harrell's C-statistic (concordance index) was used for test of discrimination and internal validation was calculated by bootstrap method. This study demonstrated greater separation of OS with HR of 6.75 (95%CI 1.94-23.51, P = .003) by using group Vb only as N3 compared to HR of 4.70 (95%CI 1.37-16.13, P = .014) by using current standard N3 disease (groups IV and Vb). Similarly, N2 with presence of Va shows worsened DFS with HR of 8.70 (95%CI 1.08-69.67, P = .042) compared to N2 without Va with HR of 5.93 (95%CI 0.76-46.00, P = .089). After incorporating cervical group V into nodal staging, the HR and 95%CI among each group was better separated than the eighth AJCC staging system but without significant improvement in C-index. Cervical lymph node group V is a potentially added prognostic factor to standard TNM staging.

Analysis of Granulomatous inflammatory lesions diagnosed on Cytology

Introduction and aim of the study Fine needle aspiration cytology FNAC plays as an important tool for diagnosing disease process. Granulomatous inflammatory lesions are common cytological findings which can be easily diagnosed. Proper diagnosis avoids unnecessary surgical intervention. The aim of the study is to describe demographic data regarding granulomatous lesions diagnosed by cytology.Materials and methodsData was retrieved from cytology records of Department of Pathology over a period of two years. Information regarding age gender site of the lesion was collected tabulated and analyzed.Results Granulomatous inflammatory lesions diagnosed on FNAC were 43. Majority 67 of cases were seen in females with MF ratio of 12.1. Many cases 55.8 concentrated between 21-40 years. Cervical lymph nodes were the most commonly involved.Conclusion From the study it was found that females were affected commonly. Granulomatous lesions affected 3rd and 4th decades more commonly. The most common organ involved was cervical group of lymph nodes.

Clinico-pathological evaluation of cervical lymphadenopathy

Introduction: Cervical lymph nodes are peripheral lymphoid organs distributed in the neck. The term lymphadenopathy refers to nodes that are palpable and abnormal in size, consistency or numbers. Diagnosis of cervical lymphadenopathy can vary from neoplasm to various kinds of infection. Accurate diagnosis of the cause of lymphadenopathy can sometimes be challenging and can lead to delay in diagnosis causing delayed treatment and subsequent health issues.
 Methods: A prospective observational study was carried out on 78 patients of cervical lymphadenopathy who presented in the surgical outpatient department of KIST Medical College. Detailed history, physical examination and necessary investigations including fine needle aspiration cytology were done in all patients
 Results: Most patients were between 21 to 40 years of age. The commonest cause for cervical lymphadenopathy was reactive lymphadenitis (53.84%) followed by Tuberculosis (34.61%). Secondary metastasis was seen in 7 patients (8.97%). In tubercular lymphadenitis, the anterior triangle group was the most commonly involved group of cervical lymph nodes (74 %), followed by the posterior triangle and supraclavicular equally (11.11%). 
 Conclusions: Reactive Lymphadenopathy is the commonest cause of cervical lymphadenopathy. However, variable diagnosis can be possible from non-neoplastic to neoplastic condition.

Management of retropharyngeal lymph node metastasis in oral cancer

ObjectivesRetropharyngeal lymph node (RPLN) metastasis is extremely rare, and prognosis is significantly poor in oral cancer. We retrospectively examined the management of RPLN metastases in oral cancer. Materials and methodsA total of 1247 patients with oral cancer were treated at our department from January 2002 and December 2016. Among these patients, 374 (30%) had histologically positive lymph node metastases. Of these, 15 patients (1.2%) were diagnosed with RPLN metastases. We evaluated the diagnostic period, size, recurrence pattern, laterality, treatment, and therapeutic outcomes. The Kaplan–Meier method was used to determine overall survival (OS) among the RPLN metastasis group, cervical lymph node (CLN) metastases group, and treatment methods group for RPLN metastases. ResultsOne patient had RPLN involvement at the initial treatment, and RPLN involvement in other patients was found subsequently. The mean duration in confirming RPLN metastases was 228 days (range, 50–867 days). Surgical therapy was performed in 5 patients, chemoradiotherapy in 7 patients, and best supported care (BSC) in 3 patients. The cumulative 5-year OS rate for the RPLN metastasis group (n = 15) was 38.1%, compared with the rate of 71.3% for the CLN group (n = 359). Regarding the therapeutic approach for RPLN metastases, OS rates were 80.0% (n = 5) in the surgical therapy group, 28.6% (n = 7) in the chemoradiotherapy group, and 0% (n = 3) in the BSC group. ConclusionEarly detection and surgical treatment of RPLN metastases are associated with increased survival rate in oral cancer.

UTILITY OF ULTRASONOGRAPHY DIAGNOSIS FOR CERVICAL LYMPHADENOPATHY IN CENTRAL INDIAN POPULATION- A HOSPITAL BASED OBSERVATIONAL STUDY

Background: Cervical lymph nodes are frequently involved in a number of disease conditions. The most commonly seen causes of cervical lymphadenopathy are tuberculosis, distant metastasis and lymphoma.
 Objective: To assess the usefulness of ultrasonography in the differential diagnosis of cervical lymphadenopathy.
 Methods: ultrasonography of cervical lymph nodes was performed with a real-time linear scanner using a 7.5- or 11-MHz probe. Ultrasonography findings were retrospectively reviewed in 432 lymphnodes of 120 patients. USG findings were reevaluated by FNAC, CECT neck, MRI and core needle biopsy wherever required.
 Results: out of 432 lymphnodes; 108 tuberculous lymphadenitis, 46 metastatic, 59 lymphoma, 114 inflammatory and 105 normal lymph nodes were observed. Ultrasonography features were found to be stronger in tubercular, metastatic and lymphomatous lymphnodes. Hypoechoic center was prominently observed in tubercular and metastatic form. In most of the patients, FNAC result was equivocal and a subsequent excision biopsy of the lymph node was carried out to confirm the diagnosis. Lymphadenitis was diagnosed with a sensitivity of 100% and a specificity of 100%.
 Conclusion: This study concluded that cervical group of lymph nodes with ultrasonography features such as round shape, absence of hilar echo, sharp nodal borders, Hypoechoic internal echogenicity and presence of intranodal necrosis were highly suggestive of metastatic cervical lymph nodes. Ultrasonography along with other radiological and histopathological parameters can be very effective in early diagnosis of high risk diseases.
 Keywords: Ultrasonography; Tuberculous Lymphadenitis; Malignant Lymphoma; Metastatic Node

Study of cytomorphological spectrum of tuberculous lymphadenitis and correlation with AFB positivity

A prospective study of lymph node FNAC was done in 500 cases presenting with tuberculous lymphadenitis over a duration of 6 months. Most of the patients were in the age group of 21-40 years, with female to male ratio of 1.9:1. Lymph node enlargement was noted in all the cases, wherein the lymph nodes were multiple, soft to firm and matted in 152 cases (30.4%) and single and discrete in 348 cases (69.6%). The most common group involved was the cervical group of lymph nodes (87.2%), followed by the axillary group (9.4%). Most cases showed whitish aspirates (56%). 21% cases showed cheesy appearance of aspirates. Associated history of contact was found in 97 cases (19.4%). 142 cases (28.4%) had past history of tuberculosis, out of which 52 cases had completed antitubercular treatment (ATT) for 9 months, while 42 cases were defaulters who had not completed ATT course. Epithelioid granuloma with necrosis (63.6%) pattern was the most common followed by epithelioid granuloma without necrosis (22.4%). 9 HIV seropositive cases (1.8%) were seen, out of which, epithelioid granuloma with necrosis and only caseous necrosis were seen in 3 cases (33.33%) each. AFB positive cases were 36%. Necrotizing lymphadenitis showed maximum AFB positivity (95.55%), which was followed by necrotizing and suppurative lymphadenitis which showed 92% AFB positivity. We did not encounter any complications during and after aspiration procedure. Keywords: Cytomorphological pattern, Tuberculous lymphadenitis, FNAC, AFB positivity.

A comparative study of diagnostic efficacy of fine needle aspiration cytology to open biopsy in cervical lymphadenopathy in a tertiary care hospital, Kanchipuram district, India

Background: Lymphadenopathy is a very common clinical manifestation of many diseases, defined as an abnormality in the size or character of lymph nodes, caused by the invasion or propagation of either inflammatory cells or neoplastic cells into the node. Objectives of this study were to evaluate the diagnostic efficacy of the fine needle aspiration cytology of cervical and axillary lymphadenopathy as compared to open biopsy for histopathological examination. A comparative study of diagnostic efficacy of FNAC cervical and axillary lymphadenopathy as compared to open biopsy for histo-pathological examination was carried out on the patients with cervical and axillary lymph adenopathy coming to OPD in Karapaga Vinayaga Medical College and Hospital, Madhuranthagam.Methods: All patients selected as per inclusion and exclusion criteria underwent FNAC of lymph node followed by open biopsy of same lymph node.Results: The results revealed that, the overall diagnostic accuracy was 82.00% with accuracy of 91.70% for tuberculous lymphadenitis and 80.00% for metastatic carcinoma with positive predictive value of 100.00%. In 50.00% of the patients, enlarged tuberculous lymph nodes were matted. Cervical group of lymph nodes were the most commonly affected group of lymph nodes (79.00%). In the present study diagnostic accuracy for metastatic carcinoma was 80.00% and for squamous cell carcinoma was 100.00%. It must be stressed that when the fine needle aspirate appears purulent or when tuberculosis is clinically suspected, specimen should be stained for acid fast bacilli.Conclusions: It improves diagnostic capability of FNAC. If FNAC is positive surgeon can proceed to treat the neck without excisional biopsy of the enlarged lymph nodes. Supraclavicular lymphadenopathy rarely represents curable disease and these nodes can be excised for histological confirmation. FNAC should be followed by open biopsy if negative. The use of flow cytometry, tumour markers, immunocytochemistry of FNA specimen have excellent potential for cytological based diagnosis.

THE PREVALENCE OF HERPES VIRUS INFECTIONS IN CHILDREN WITH HYPERTROPHY OF THE GLUTAL MINDALINE

Objective: to evaluate the clinical and epidemiological features of chronic adenoiditis and adenotonzillitis in children with nasopharyngeal carriage of the Epstein-Barr virus, cytomegalovirus and human herpesvirus 6. We conducted open comparative study, which involved 200 patients undergoing conservative and surgical treatment (adenotomy, adenotonzillotomy) at the ENT department of the Medical Center “Mart” (Kazan).Results. We obtained positive result of herpesvirus test in 65% (95% CI 58.4–71.6), 130/200 cases. There were registered 92 cases of the Epstein-Barr virus infection (70.8% [95% CI 63–78.6]), 46 – cytomegalovirus (35.4% [95% CI 27.2–43.6]) and 56 – human herpesvirus 6 (43.1% [95% CI 34.6–51.6]). 100% of patients with herpesvirus 6 had recurrent respiratory diseases, an increase in the cervical group of lymph nodes; 36.4% (95% CI 16.4–56.4%), 8/22 of these patients did not need operative treatment. Patients with the Epstein-Barr virus, cytomegalovirus and their combination more often complained of hypertrophy of the pharyngeal tonsil, recurrent otitis and a decrease in hearing, p<0.01. Patients with Epstein-Barr virus infection (11.9% [95% CI 2.2–21.6]), 5/42) were more often dissatisfied with the treatment results.Conclusion: effective options of treatment and prevention of hypertrophy of the lymphoid tissue of the pharyngeal ring should include etiotropic therapy of herpesvirus infections.

A clinicopathological study on cervical lymphadenopathy: an institutional experience

Background: Despite advances in modern technology accurate diagnosis of cause of cervical lymphadenopathy remains a challenge. It leads to substantial morbidity to patients and sometimes even mortality. Uncertainty in diagnosis can lead to wrong diagnosis and increases cost of treatment. The objective of the study was to conduct a detailed evaluation of cervical lymphadenopathy in tertiary care set up and to enumerate the causes so that appropriate and adequate treatment can be initiated to reduce the morbidity.Methods: A prospective study was carried out on 100 patients of cervical lymphadenopathy and were evaluated clinically. Detailed history was taken of every patient followed by physical examination and appropriate investigations. This was followed by disease specific treatment and surgical intervention wherever necessary. Patient data was collected and evaluated to draw conclusions.Results: Most patients were young (between 12-40 years). Most common cause for cervical lymphadenopathy is due to non-neoplastic (82%) and less commonly from neoplastic (18 %). In non-neoplastic causes most, common cause is due to tuberculosis (51 %). In neoplastic causes, most common cause is due to lymphoma (10 %). In tubercular lymphadenitis the posterior triangle group was the most commonly involved group of cervical lymph nodes (31.3%), followed by upper jugular group (21.5%). FNAC by virtue of it being inexpensive, quick in getting the results and easy to perform, is one of the important and essential diagnostic procedure. Surgery should be to diagnostic biopsy, for treatment of abscess/sinuses and for a lymph node that do not resolve with chemotherapy and as an adjuvant to chemotherapy.Conclusions: Cervical lymphadenopathy can have varied manifestation from non-neoplastic to neoplastic condition. Proper history examination and relevant investigations and disease specific treatment can only cure the patient and improve the prognosis.

PO-0703: Added value of metastatic cervical lymph node group V in nodal staging of nasopharyngeal cancer

PO-0703: Added value of metastatic cervical lymph node group V in nodal staging of nasopharyngeal cancer