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Structured Reporting of Lymph Node Cytopathology using the 2020 Sydney System Guidelines-A Retrospective Study

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Title: Structured Reporting of Lymph Node Cytopathology using the 2020 Sydney System Guidelines-A Retrospective Study
Authors: Sreelekshmi, Jayasree Raman, Tessy Petta Joseph
Source: National Journal of Laboratory Medicine, Vol 12, Iss 2, Pp PO39-PO44 (2023)
Publisher Information: JCDR Research and Publications Pvt. Ltd., 2023.
Publication Year: 2023
Collection: LCC:Microbiology
LCC:Chemistry
Subject Terms: cytopathology, fine needle aspiration cytology, lymph node, malignancy risk, sydney system, Microbiology, QR1-502, Chemistry, QD1-999
More Details: Introduction: Fine Needle Aspiration Cytology (FNAC) is a valuable diagnostic aid for evaluation of lymph node pathology. The new Sydney System (2020) for classification and reporting of lymph node FNAC has put forth guidelines for a categorical classification using uniform terminology and morphologic criteria, a major step towards standardisation. Aim: The study was aimed to evaluate cytopathology of lymph node lesions during 2 year period by applying the proposed Sydney system and to assess the category wise Risk Of Malignancy (ROM) by comparing with histopathology diagnosis in available cases. Materials and Methods: A retrospective observational study was conducted in 2021 December, on lymph node aspirates obtained during two-year period from January 2018 till January 2020 in the department of Pathology of a tertiary care centre. FNAC of 250 lymph node aspirates were evaluated. Smears were reviewed and categorised as per the Sydney System of reporting as, L1: non diagnostic/inadequate, L2: benign, L3: atypical cells/atypical lymphoid cells of undetermined significance, L4: suspicious for malignancy, L5: malignant. The diagnostic accuracy of cytology and ROM in each category was assessed comparing with the gold standard histopathology diagnosis where available. Results: Category wise distribution of 250 cytological diagnosis of lymphadenopathy reclassified in Sydney system were L1-14 (5.60%); L2-159 (63.60%); L3-04 (1.60%); L4-05 (2%); and L5-68 (27.20%) cases. Using histopathology as gold standard available in 53 cases, the ROM in each category was found to be 0%, 3%, 66.66%, 100% and 100%, respectively. The sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and diagnostic accuracy of cytological diagnosis was found to be 95.65%, 96.29%, 95.65%, 96.29% and 96%, respectively. Reactive lymphadenitis in 86 (34.40%) and metastatic carcinoma in 61 (24.40%) cases were the most common benign and malignant lesions respectively. Conclusion: The Sydney system of structured reporting in lymph node cytology provides a clear-cut terminology, uniformity, and reproducibility of reports. It enhances the role of FNAC by alerting the clinician for follow-up and ancillary studies in atypical and equivocal cases. In the non diagnostic L1 category, repeat procedure or biopsy should be recommended to avoid False Negative (FN) diagnosis.
Document Type: article
File Description: electronic resource
Language: English
ISSN: 2277-8551
2455-6882
86973029
Relation: https://njlm.net/article_FULLTEXT.aspx?issn=0973-709x&year=2023&month=April&volume=12&issue=2&page=PO39%20-%20PO44&id=2722; https://doaj.org/toc/2277-8551; https://doaj.org/toc/2455-6882
DOI: 10.7860/NJLM/2023/61109.2722
Access URL: https://doaj.org/article/2ddb556cf60e4b86973029081e0e7485
Accession Number: edsdoj.2ddb556cf60e4b86973029081e0e7485
Database: Directory of Open Access Journals
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  Data: National Journal of Laboratory Medicine, Vol 12, Iss 2, Pp PO39-PO44 (2023)
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  Data: LCC:Microbiology<br />LCC:Chemistry
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  Data: <searchLink fieldCode="DE" term="%22cytopathology%22">cytopathology</searchLink><br /><searchLink fieldCode="DE" term="%22fine+needle+aspiration+cytology%22">fine needle aspiration cytology</searchLink><br /><searchLink fieldCode="DE" term="%22lymph+node%22">lymph node</searchLink><br /><searchLink fieldCode="DE" term="%22malignancy+risk%22">malignancy risk</searchLink><br /><searchLink fieldCode="DE" term="%22sydney+system%22">sydney system</searchLink><br /><searchLink fieldCode="DE" term="%22Microbiology%22">Microbiology</searchLink><br /><searchLink fieldCode="DE" term="%22QR1-502%22">QR1-502</searchLink><br /><searchLink fieldCode="DE" term="%22Chemistry%22">Chemistry</searchLink><br /><searchLink fieldCode="DE" term="%22QD1-999%22">QD1-999</searchLink>
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  Label: Description
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  Data: Introduction: Fine Needle Aspiration Cytology (FNAC) is a valuable diagnostic aid for evaluation of lymph node pathology. The new Sydney System (2020) for classification and reporting of lymph node FNAC has put forth guidelines for a categorical classification using uniform terminology and morphologic criteria, a major step towards standardisation. Aim: The study was aimed to evaluate cytopathology of lymph node lesions during 2 year period by applying the proposed Sydney system and to assess the category wise Risk Of Malignancy (ROM) by comparing with histopathology diagnosis in available cases. Materials and Methods: A retrospective observational study was conducted in 2021 December, on lymph node aspirates obtained during two-year period from January 2018 till January 2020 in the department of Pathology of a tertiary care centre. FNAC of 250 lymph node aspirates were evaluated. Smears were reviewed and categorised as per the Sydney System of reporting as, L1: non diagnostic/inadequate, L2: benign, L3: atypical cells/atypical lymphoid cells of undetermined significance, L4: suspicious for malignancy, L5: malignant. The diagnostic accuracy of cytology and ROM in each category was assessed comparing with the gold standard histopathology diagnosis where available. Results: Category wise distribution of 250 cytological diagnosis of lymphadenopathy reclassified in Sydney system were L1-14 (5.60%); L2-159 (63.60%); L3-04 (1.60%); L4-05 (2%); and L5-68 (27.20%) cases. Using histopathology as gold standard available in 53 cases, the ROM in each category was found to be 0%, 3%, 66.66%, 100% and 100%, respectively. The sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and diagnostic accuracy of cytological diagnosis was found to be 95.65%, 96.29%, 95.65%, 96.29% and 96%, respectively. Reactive lymphadenitis in 86 (34.40%) and metastatic carcinoma in 61 (24.40%) cases were the most common benign and malignant lesions respectively. Conclusion: The Sydney system of structured reporting in lymph node cytology provides a clear-cut terminology, uniformity, and reproducibility of reports. It enhances the role of FNAC by alerting the clinician for follow-up and ancillary studies in atypical and equivocal cases. In the non diagnostic L1 category, repeat procedure or biopsy should be recommended to avoid False Negative (FN) diagnosis.
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        Value: 10.7860/NJLM/2023/61109.2722
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      – Text: English
    Subjects:
      – SubjectFull: cytopathology
        Type: general
      – SubjectFull: fine needle aspiration cytology
        Type: general
      – SubjectFull: lymph node
        Type: general
      – SubjectFull: malignancy risk
        Type: general
      – SubjectFull: sydney system
        Type: general
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      – TitleFull: Structured Reporting of Lymph Node Cytopathology using the 2020 Sydney System Guidelines-A Retrospective Study
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