APPLICABILITY OF THE PROPOSED SYDNEY SYSTEM: CLASSIFICATION AND REPORTING OF LYMPH NODE FINE-NEEDLE CYTOLOGY

Most of the disease conditions whether benign or malignancypresents as lymphadenopathy. Therefore, first line evaluation of lymphadenopathy of unknown etiology, fine-needle aspiration cytology (FNC) act as an important diagnostic tool. Recently, an expert panel published the proposal of the Sydney system for reporting and classification of lymph node cytopathology. The aim of the present study was to evaluate the applicability of Sydney system of classification and reporting. Material and method: It is retrospective study done in tertiary health care center in which FNC diagnoses were correlated with histopathological and clinical follow-up, to assess the diagnostic accuracy and the risk of malignancy (ROM) for each diagnostic category. A total of 1204 lymph node FNCs that were performed between 1st of January 2021to 31st of August 2021 were reviewed. Results: Out of 1204 cases, n=127 cases (10.5%) were re-categorized as L1-inadequate/non-diagnostic n = 805 (66.8%) as benign (L2) n = 12 (0.99%) as atypical (L3) n = 15 (1.24%) as suspicious (L4), and n = 241 (20%) as malignant (L5). Statistical analysis: Sensitivity 99.37%, specificity 98.31%, positive predictive value 99.6%, negative predictive value 98.5%, and accuracy 98.12%. The ROM was 100% for L4 and L5category, 66.6% for L3, 1.51% and 0.66% for L1 and L2 categories, respectively. Conclusion:In lymph node FNC reporting, diagnostic accuracy can be improved by the implementation of Sydney system of classification and reporting. Moreover management recommendation specific for each categories with increased ROM that enables the clinician with better management of patient care.