Fine needle aspiration cytology (FNAC) as a diagnostic tool in cervical lymphadenopathy in paediatric population

Background: Lymphadenopathy (LAP) is a commonly encountered clinical problem in the pediatric population which has a multitude of causes. Cervical lymphadenopathy is the commonest form of peripheral lymphadenopathy and is a major concern amongst the parents. Fine needle aspiration cytology (FNAC) of lymph node has become an integral part of the initial diagnosis and management of patients with lymphadenopathy due to early availability of results, simplicity, and minimal trauma with less complication. Materials and method: All children upto the age of 16 years presenting to the Department of Pediatric Surgery, Pt. B. D. Sharma, PGIMS Rohtak, Haryana, India with LAP of the neck and head were included in the study group. Lymph nodes that were enlarged more than 10 mm in the cervical, submental, and submandibular region, and 5 mm in the suboccipital, preauricular and postauricular region, were accepted as LAP. LAP that lasted less than 4 weeks was termed as acute LAP and 4 weeks or more as chronic LAP. Results: Among all groups, 57.6% (n = 568) were girls, and the maximum number of cases were in 5-10 age group with mean age 7 years and female: male ratio of 1.35:1. 15.4% pre-cervical, 36.3% submandibular, 25.7% post cervical, 19.9% retroauricular and 02.7% supraclavicular. Patients were divided into two groups: patients with no malignancy (group 1; n=782), and patients with malignancy (group 2; n=204). Five hundred seventy three patients (58.1%) had acute LAP and 41.8% (n = 413) had chronic symptoms. Mean lymph node size was 27.5 ± 5.8 mm in group 1 and 29.2 ± 5.0 mm in group 2. The commonest cause of lymphadenopathy in children was reactive hyperplasia followed by tuberculosis Conclusion: A thorough clinical history, examination (both local and systemic), routine and some special investigations should be considered to arrive at the diagnosis of paediatric cervical lymphadenopathy. FNAC is an accurate diagnostic technique in diagnosing various etiologies of lymphadenopathy. It provides a reliable, safe, rapid and economical method of investigating lymph node enlargement, the accuracy of which approaches that of other diagnostic procedures.