Percutaneous aspiration biopsy of lymph nodes

During a period of five years, 361 patients each had cytologic examination of a specimen aspirated by percutaneous needle biopsy from a superficial lymph node. Fifty-five aspirates were considered unsatisfactory owing to scanty cellularity, and 22 were excluded because of lack of adequate follow-up. Of the remaining 284 aspirates, 81% were positive for malignant cells; 19% were considered negative. There were no cases with false-positive diagnoses. However, of 52 negative aspirates, 31 revealed tumor on subsequent excisional biopsy. Seventy-two percent of patients were admitted with prior history of malignancy. For both males and females, an apparent correlation was found between regional distribution of positive lymph nodes and the histologic types of primary tumors. Eighty-two percent of the positive cervical nodes in males and 56% in females were associated with epidermoid carcinoma. Most of the positive supraclavicular and axillary lymph nodes occurred in females and were associated with mammary carcinoma. Diagnosis of malignant neoplasms is feasible, in most instances, from nodal aspirates, but specific diagnosis of the histologic type of the tumor, e.g., malignant lymphoma, should be rendered only when the cytologic findings are supported by appropriate clinical and laboratory findings. In case of doubt, or if the aspirate contains many polymorphonuclear leukocytes, necrotic debris, or bizarre epithelioid cells, granulomatous lymphadenitis should be suspected and the diagnosis should be deferred until formal tissue biopsy can be obtained.