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A roadmap for a comprehensive diagnostic approach to fine needle cytology of lymph node metastases

OBJECTIVE: Fine needle cytology (FNC) is widely used as a first‐line procedure in the diagnostic algorithm of lymphadenopathies. In a metastatic setting, a first‐line diagnostic approach identifies non‐haematopoietic malignancy; however, cytopathologists could also provide a second diagnostic level,...

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Detalles Bibliográficos
Autores principales: Acanfora, Gennaro, Iaccarino, Antonino, Dello Iacovo, Filippo, Pisapia, Pasquale, De Luca, Caterina, Giordano, Claudia, Bellevicine, Claudio, Picardi, Marco, Troncone, Giancarlo, Vigliar, Elena
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9826057/
https://www.ncbi.nlm.nih.gov/pubmed/35986701
http://dx.doi.org/10.1111/cyt.13172
Descripción
Sumario:OBJECTIVE: Fine needle cytology (FNC) is widely used as a first‐line procedure in the diagnostic algorithm of lymphadenopathies. In a metastatic setting, a first‐line diagnostic approach identifies non‐haematopoietic malignancy; however, cytopathologists could also provide a second diagnostic level, identifying the origin of the primary tumour. This paper outlines a comprehensive and practical approach to the cytological diagnosis of lymph node metastases. METHODS: Cytological diagnoses of lymph node metastases performed over a 10‐year period were selected and divided into two groups. The first group, labelled “oncological,” comprised patients with a previous history of malignancy; the second group, labelled “naïve,” included patients with no relevant history. Pathology records were retrieved to record microscopic findings, namely, background appearance, group architecture, and specific cell features; data from cell block (CB) preparations were also collected. RESULTS: Overall, 982 cases were selected: 497 cases (50.61%) in the naïve group, and 485 (49.39%) in the oncological group. Overall, a second diagnostic level was achieved in 834/982 cases (84.92%); cases diagnosed as carcinoma not otherwise specified were more frequent in the naïve group than in the oncological group (17.51% vs. 8.04%, P < 0.01). Notably, although CB material was available in only 44.87% of the naïve cases, we were able to achieve a second diagnostic level thanks to the integration of clinical and cytomorphological findings, plus lymph node topography, in 82.49% of the cases. CONCLUSION: Our results confirmed that in a metastatic setting, FNC can reliably lead to the identification of the origin of the primary tumour.