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Pitfalls in Lymph Node Fine Needle Aspiration Cytology
1Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Acta Cytologica
|December 20, 2023
Summary
Fine needle aspiration cytology (FNAC) for lymph nodes can misdiagnose lymphoma. Pathologists must recognize pitfalls leading to false-negative or false-positive results for accurate diagnosis.
Area of Science:
- Cytopathology
- Surgical Pathology
- Oncology
Background:
- Fine needle aspiration cytology (FNAC) is a valuable tool for enlarged lymph nodes.
- Its role in diagnosing infectious/reactive conditions and metastatic malignancy is established.
- Debate continues regarding its utility in lymphoma diagnosis, with inherent pitfalls.
Purpose of the Study:
- To discuss potential interpretational errors in lymph node FNAC.
- To highlight scenarios causing false-negative and false-positive diagnoses.
- To emphasize awareness of 'off-radar' entities and diagnostic traps.
Main Methods:
- Review of diagnostic pitfalls in lymph node FNAC.
- Emphasis on cytomorphology and differential diagnoses.
- Discussion of specific entities causing misdiagnosis.
Main Results:
- False-negative diagnoses can result from low-grade lymphomas or paucicellular aspirates.
- False-positive diagnoses may arise from viral lymphadenopathy or benign mimics.
- Tumor classification errors include mimics of carcinoma, sarcoma, melanoma, and lymphoma.
Conclusions:
- Awareness of diagnostic pitfalls is crucial for pathologists.
- Consideration of broad differentials, including 'off-radar' entities, is recommended.
- A triple approach involving clinicopathologic correlation, cytomorphology, and ancillary tests aids accurate diagnosis.
