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Abstract

Study background: Fine needle aspiration cytology (FNAC) is a safe, easy, quick, cost effective technique for aspirating any visible, superficial , palpable masses including lymph nodes. The indications for lymph node FNAC include the diagnosis of reactive lymph nodes, metastatic tumours, lymphoproliferative disorders and for tumour staging purposes. AIM: to correlate the diagnostic accuracy of FNAC performed on lymph nodes when compared to the corresponding histology. Hypothesis: there is high accuracy , specificity and sensitivity in FNAC in diagnosing disease when compared to the corresponding histology. Objectives: To evaluate the accuracy of fine needle aspirate cytology and its correlation with clinical and histopathological findings. To determine the specificity and the sensitivity of fine needle aspiration cytology in differentiating between benign and malignant lesions. To assess the importance of fine needle aspiration cytology in providing a final diagnosis for therapeutic intervention Methods: This was a retrospective qualitative study. The study included records of patients who underwent FNAC with the indication of lymphadenopathy at the FNA clinic between 1st January 2018 and December 31st, 2019. All cytology and histology reports were retrieved from the National Health Laboratory Services (NHLS) �AARMS department. All reported cytology specimens with their corresponding histology reports during the study period were utilized for the purpose of the study. The cytology reports were classified as unsatisfactory, benign, atypia and malignant. These results were compared with the corresponding histologic results. For each category, the risk of malignancy was determined by calculating the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Discussion: Sensitivity, specificity , PPV and NPV are 43.3% , 100% , 100% and 68.5%. The sensitivity in our study is low at 43.3% when compared to other studies which range from 70- 100%. The cause is multifactorial and includes the technique of the aspirator, the quality of the stain ,the experience of the Pathologist who is signing out and the availability of Rapid On Site Evaluation at the clinic. ROSE is a cytology technique which is used during interventional diagnostic procedure to prepare the slides, stain and examine them on site under light microscopy. The specificity and positive predictive values are both 100% in this study which confirms the value of FNAC in positively screening and diagnosis patients with a disease. Conclusion: FNAC is a good diagnostic test for screening and diagnosing nonneoplastic and neoplastic conditions. The results of this study show there is room for improvement; retraining registrars and Medical Officers in FNAC technique; using cell blocks for ancillary tests, Gene Xpert and Flow cytometry, with implementation of Liquid based Cytology � improvement; Pathologist should have a high index of suspicion for abnormality when checking registrar slides. A larger cohort of patients maybe will give different results.

Biography

Dr Jackie Chokoe Malulekema is an Anatomical Pathologist at D7 Anatomical Pathology National Health Laboratory Service New Groote Schuur Hospital, University of Cape Town, South Africa