Fine-needle aspiration in the management of peripheral lymphadenopathy in a developing country

Fine-needle aspiration (FNA) is a simple, cheap, and well-tolerated procedure that is well-established as a method of definitive diagnosis of palpable masses. This review reports the role of FNA in the investigation of peripheral lymphadenopathy as an alternative to expensive surgical excision biopsy in developing countries, where there are limited funds and facilities. All lymph node aspirates done in the FNA clinic at the Department of Pathology, University College Hospital, Ibadan, between 1995-1997 were reviewed. The aspirates were obtained using 21- or 22-gauge needle with a 5- or 10-ml disposable plastic syringe, smeared on standard microscopic slides and stained with Giemsa and/or Papanicolou stains. The most common diagnosis was reactive change/nonspecific inflammation, constituting 33.4%; tuberculosis and metastatic lesions made up 25. 7% and 22.4%, respectively, while lymphoma constituted 16.9% of cases. The commonly aspirated nodes were cervical. Tuberculosis was the most frequent diagnosis in these nodes and was the most commonly diagnosed infective condition, particularly in those under age 20 years. The sensitivity and specificity of lymph node FNA in the diagnosis of tuberculosis were 79.5% and 100%, respectively. The overall accuracy rate of lymph node aspiration was 89.5%. Our study showed that FNA is a simple, cost-effective procedure which offers a reliable method of diagnosis in distinguishing reactive lymphadenopathy, tuberculosis, and malignant conditions. Diagn. Cytopathol. 1999;21:159-162.