JOURNAL OF EVIDENCE BASED MEDICINE AND HEALTHCARE

Table of Contents

2018 Month : February Volume : 5 Issue : 6 Page : 522-526

FINE NEEDLE ASPIRATION CYTOLOGY OF SUPRACLAVICULAR LYMPH NODE- THREE YEAR RETROSPECTIVE STUDY

Divya Radhakrishnan1, Rajan Gopalan Nair2, Sathi P. P3, K. Rajasree Varma4

1. Senior Resident, Department of Pathology, Government Medical College, Kozhikode.
2. Additional, Professor, Department of Pathology, Government Medical College, Kozhikode.
3. Professor, Department of Pathology, Government Medical College, Kozhikode.
4. Senior Resident, Department of Pathology, Government Medical College, Kozhikode.

Corresponding Author:
Dr. Rajan Gopalan Nair,
Additional Professor,
Department of Pathology,
Government Medical College, Kozhikode.
E-mail: rajanrema@yahoo.com
DOI: 10.18410/jebmh/2018/106

ABSTRACT
BACKGROUND
Lymphadenopathy especially in the supraclavicular region is often associated with an underlying pathology. Fine needle aspiration cytology of lymph nodes is a cost effective and simple procedure that can be carried out in the outpatient department itself which helps in deciding the management.

MATERIALS AND METHODS
The study was done in Department of Pathology, Govt. Medical College, Kozhikode. Data of past 3 years (January 2014 - December 2016) was retrieved from records of the pathology department and reviewed. Relevant history, clinical examination findings and investigations were documented. Aspiration was done routinely using 23 gauge needle and smears wet fixed in isopropyl alcohol and Papanicolaou staining was done. Cases in which aspirate was inadequate were excluded from the study. The cases were broadly divided into following groups, viz., reactive lymphoid hyperplasia, acute suppurative lymphadenitis, granulomatous lymphadenitis, metastatic malignancy, lymphoma and miscellaneous cases.

RESULTS
A total number of 724 cases were included in the study, males constituted 66% and females 34%. Metastatic malignancy constituting 65% was the commonest cause of lymph node enlargement, followed by reactive hyperplasia 22%. Granulomatous lymphadenitis was diagnosed in 64 cases (8.8%). Rest of the causes like lymphoma, suppurative and non-specific causes constituted only a minor category. Most common site of lymphadenopathy was left side, constituting 59.4%. Metastatic malignancy was the commonest cause of supraclavicular enlargement in the age group of 40-80 yrs. On analyzing histopathology adenocarcinoma was the most common type in this study constituting 55% followed by squamous cell carcinoma in 27%. Approximately 11% were metastasis from small cell carcinoma and 5% from poorly differentiated carcinoma. In metastatic adenocarcinoma, the most common primary site was lung, constituting 54.2%.

CONCLUSION
Supraclavicular lymphadenopathy is most often associated with an underlying pathology and it has to be evaluated especially in the elderly. FNAC is a cheap and reliable diagnostic tool in the initial evaluation as well as follow up of patients attending outpatient department and provides valuable information that helps in treating patients.

KEYWORDS
Supraclavicular Lymphadenopathy, Aspiration Cytology, Granuloma, Carcinoma.

How to cite this article

Radhakrishnan D, Nair RG, Sathi PP, et al. Fine needle aspiration cytology of supraclavicular lymph node– three year retrospective study. J. Evid. Based Med. Healthc. 2018; 5(6), 522-526. DOI: 10.18410/jebmh/2018/106

BACKGROUND

Lymphadenopathy especially in the supraclavicular region is one of the commonest clinical presentations of patients, attending the outdoor department. It often has some underlying pathology both in young adults and old patients.1 It may be just a reactive change or due to infectious

aetiology like Tuberculosis, toxoplasmosis or it may be the first clinical manifestation of an underlying malignancy.

Fine needle aspiration cytology is an excellent cost effective diagnostic procedure that can be carried in outpatients to evaluate lymphadenopathy. It causes minimal trauma and complications are very rarely encountered. Guided FNAC with the help of CT, USG is also being practiced in difficult cases.2

 

Aims and Objectives-

In this retrospective study, we attempted to analyze and categories the pattern of supraclavicular lymph node enlargement.

MATERIALS AND METHODS

This retrospective study was carried out in Department of Pathology, Govt. Medical College, Kozhikode. Data of past 3 years (January 2014 - December 2016) was retrieved from records of the pathology department and reviewed. Relevant history, clinical examination findings and investigations were documented. Aspiration was done routinely using 23 gauge needle and smears wet fixed in isopropyl alcohol and Papanicolaou staining was done. Special stains like AFB were done in indicated cases. Cases in which aspirate was inadequate were excluded from the study.

The cases were broadly divided into following groups, viz., reactive lymphoid hyperplasia, acute suppurative lymphadenitis, granulomatous lymphadenitis, metastatic malignancy, lymphoma and miscellaneous cases.

 

RESULTS

A total number of 724 cases were included in the study, males constituted 66% and females 34% (Table 1).

 

Gender

Frequency

Percentage

Female

243

33.6

Male

481

66.4

Total

724

100.0

Table 1. Gender Distribution of the Subjects

 

The causes for lymph node enlargement are classified into six categories as shown in the Table 2 below. Metastatic malignancy (constituting 65%) was the commonest cause of lymph node enlargement, followed by reactive hyperplasia (22%). Granulomatous lymphadenitis (Figure 1) was diagnosed in 64 cases (8.8%), which included 35 cases of Tuberculosis. Definitive diagnosis of Tuberculosis was given for cases in which there was granuloma along with caseous necrosis or those cases in which AFB stain was positive. Rest of the causes like lymphoma, supportive and non-specific causes constituted only a minor category.

 

 

Frequency

Percentage

Granulomatous

64

8.8

Lymphoma

13

1.8

Metastatic Malignancy

471

65.1

Non specific

10

1.4

Reactive

152

21.0

Suppurative

14

1.9

Total

724

100.0

Table 2. Causes of Supraclavicular Lymphadenopathy

 

Figure 1. Granulomatous Lymphadenitis, Papanicolaou Stain, 40x

Most common site of lymphadenopathy was left side, constituting 59.4%.

 

 

Frequency

Percentage

Left

430

59.4

Right

294

40.6

Total

724

100.0

Table 3. Side of Enlargement

 

Metastatic malignancy was the commonest cause of supraclavicular enlargement in the age group of 40- 80 yrs. as shown in the Table 4.

 

Age Group

Cause of Supraclavicular Lymphadenopathy

Granulomatous

Lymphoma

Metastatic Malignancy

Non-Specific

Reactive

Suppurative

Total

<10

1

0

0

0

0

1

3

11-20

2

2

0

3

7

2

16

21-30

7

1

4

1

10

7

25

31-40

17

2

20

3

18

17

62

41-50

13

0

73

1

29

13

118

51-60

15

3

149

2

55

15

226

61-70

4

5

153

0

24

4

187

71-80

3

0

62

0

5

3

71

>80

2

0

10

0

4

2

16

Total

64

13

471

10

152

64

724

Table 4. Pattern of Lymphadenopathy

Based on Age Group

 

On analysing histopathology (Table 5), adenocarcinoma (Figure 2) was the most common type in this study constituting 55% (260/471) followed by squamous cell carcinoma (Figure 3) in 27% (126/471). Approximately 11% (50/471) were metastasis from small cell carcinoma (Figure 4) and 5% (24/471) from poorly differentiated carcinoma. There were a few cases of malignant melanoma, papillary carcinoma thyroid and single case of urothelial, Wilms tumour, neuro endocrine carcinoma and germ cell tumor.

 

Figure 2. Metastasis from Adenocarcinoma, Papanicolaou Stain, 40x

Figure 3. Metastasis from Squamous Cell Carcinoma, Papanicolaou Stain, 40x

Figure 4. Metastasis from Small Cell Carcinoma, Papanicolaou Stain, 40x

 

 

Frequency

Percentage

Adenocarcinoma

260

55.2

Follicular ca (thyroid)

1

2

Germ cell tumor

1

2

Malignant melanoma

3

6

Neuro endocrine ca

1

2

Papillary ca (thyroid)

3

6

Poorly differentiated

24

5.1

Small cell carcinoma

50

10.6

Squamous cell ca

126

26.8

Urothelial carcinoma

1

2

Wilms

1

2

Total

471

100.0

Table 5. Histopathological Analysis

of the Subjects

 

In metastatic adenocarcinoma, the most common primary site was lung, constituting 54.2% (141/260 cases), followed by breast (37/260) (Figure 5), stomach (35/260) (Figure 6) and few cases from cervix, pancreas, prostate, kidney, ovary, as shown in Table 6. In 26 cases, primary site was not known.