European Journal of Cardiovascular Medicine

Lymphadenopathy is a common clinical finding encountered in both outpatient and inpatient settings, with causes ranging from benign reactive conditions and infectious diseases to primary or metastatic malignancies. Accurate identification of the underlying etiology is essential for timely diagnosis, appropriate treatment, and improved patient outcomes. Although excisional biopsy followed by histopathological examination remains the diagnostic gold standard, it is invasive, relatively expensive, time-consuming, and may not be necessary in all patients presenting with enlarged lymph nodes.1

Fine needle aspiration cytology (FNAC) has emerged as a reliable first-line diagnostic modality for the evaluation of superficial lymphadenopathy. It is a simple, minimally invasive, cost-effective, and well-tolerated procedure that provides rapid cytological assessment with minimal patient

discomfort.2,3,4 The technique is particularly valuable in outpatient departments and resource-limited healthcare settings, where prompt diagnosis is crucial and access to advanced diagnostic facilities may be restricted. Furthermore, radiologically guided FNAC can improve diagnostic accuracy in deep-seated or difficult-to-access lymph nodes.

The spectrum of lymph node pathology includes reactive hyperplasia, granulomatous inflammation, tuberculosis, lymphoma, and metastatic malignancies.5 Cervical lymph nodes are the most frequently involved group, although enlargement may occur at any superficial nodal site. Early cytological evaluation not only facilitates the initiation of appropriate medical or surgical management but also reduces the need for unnecessary surgical biopsies in patients with benign conditions. In patients with known malignancies, FNAC is also useful for detecting metastatic disease, recurrence, and guiding further ancillary investigations such as microbiological culture, flow cytometry, or immunocytochemistry when indicated.6

The present study was undertaken to evaluate the cytomorphological spectrum of lymph node lesions diagnosed by FNAC and to determine the relative frequency of different pathological conditions responsible for lymphadenopathy among patients attending our tertiary care centre.

A retrospective observational study was conducted in the Cytopathology section of the Department of Pathology, ESIC Medical College and Hospital, Namkum, Ranchi. The study included all patients who underwent fine needle aspiration cytology (FNAC) for superficial lymph node enlargement over a period of 24 months between 1 January 2024 and 1 January 2026. A total of 96 patients presenting with single or multiple palpable superficial lymph nodes were included in the study. Patients referred to the Cytopathology Department for FNAC evaluation of enlarged superficial lymph nodes during the study period were enrolled irrespective of age or sex. Clinical details, including demographic information and relevant medical history, were obtained from the laboratory requisition forms and hospital records. Informed consent was obtained from all patients prior to the procedure. FNAC was performed under aseptic precautions using a 22- or 23-gauge needle attached to a 10-mL disposable syringe. Aspirated material was evenly spread onto clean glass slides. Depending on the adequacy of the specimen, smears were either immediately fixed in 95% methanol for Papanicolaou staining or air-dried for May-Grünwald-Giemsa (MGG)/Giemsa staining. In cases yielding scanty aspirate, all prepared smears were wet-fixed to maximize cellular preservation. Wet-fixed smears were stained using Papanicolaou stain, whereas air-dried smears were stained with May-Grünwald-Giemsa (MGG) or Giemsa stain following standard laboratory protocols. All stained slides were mounted with coverslips and examined independently under light microscopy by experienced pathologists. Ziehl–Neelsen staining for acid-fast bacilli (AFB) was performed in cases where tuberculous lymphadenitis was clinically or cytologically suspected. Patients diagnosed with metastatic malignancy or lymphoproliferative disorders on FNAC were advised to undergo further evaluation,including histopathological examination and immunohistochemistry/immunocytochemistry, at higher referral centres whenever indicated. The cytological diagnoses were categorized according to the underlying pathological lesions. Demographic variables, including age and sex, along with the spectrum and frequency of lymph node lesions, were analyzed using descriptive statistical methods and presented as numbers and percentages.

During the two-year study period, 96 patients underwent FNAC for evaluation of enlarged superficial lymph nodes. The patients ranged in age from 5 to 85 years. Most patients belonged to the 20–39 years age group (65 cases; 67.7%), followed by the 40–59 years age group (15 cases; 15.6%) and the 0–19 years age group (10 cases; 10.4%).

Of the total study population, 60 (62.5%) were males and 36 (37.5%) were females, resulting in a male-to-female ratio of 1.7:1.

FNAC demonstrated that the majority of lymph node lesions were non-neoplastic, with inflammatory lesions accounting for 91 cases (94.8%). Neoplastic lesions were diagnosed in 3 cases (3.1%), while 2 cases (2.1%) showed nonspecific or inconclusive cytological findings.

Reactive lymphadenitis represented the most frequent cytological diagnosis, comprising 65 cases (67.7%). Acute suppurative lymphadenitis was the second most common lesion and was identified in 12 patients (12.5%). Granulomatous lymphadenitis, including tuberculous lymphadenitis, accounted for 10 cases (10.4%). Neoplastic lesions constituted only a small fraction of cases (3.1%), confirming the predominance of benign inflammatory conditions among patients presenting with superficial lymphadenopathy.

Table 1: Gender wise Distribution of lesions on lymph node FNAC

Table 2: Age wise distribution of lesions on lymph node FNAC

Table 3: Distribution of FNAC Diagnosis of Cases of Lymphadenopathy

Table 4: Summary of FNAC of lymphadenopathy

Lymphadenopathy is one of the most common clinical presentations encountered in routine medical practice and encompasses a wide spectrum of pathological conditions ranging from self-limiting reactive processes to serious infectious diseases and malignancies. An accurate and timely diagnosis is crucial for determining the appropriate management strategy. Fine needle aspiration cytology (FNAC) has become the preferred initial diagnostic modality for evaluating palpable lymph nodes because it is minimally invasive, rapid, inexpensive, and capable of providing reliable cytomorphological information. The present study evaluated the cytological spectrum of superficial lymphadenopathy over a two-year period and demonstrated that the majority of lesions were benign inflammatory conditions, reaffirming the important role of FNAC in routine diagnostic practice.

The patients included in the present study ranged from 5 to 85 years of age, with the highest incidence observed in the 20–39-year age group. Our study is correlated with the study conducted by other authors Prabhakar Patro et al7 , Smita et al8 and Kumar et al9. The predominance of young adults is consistent with the epidemiological pattern of lymphadenopathy observed in many developing countries, where infectious and inflammatory diseases remain major contributors to lymph node enlargement. Young adults are more frequently exposed to environmental pathogens and infectious agents, resulting in a greater incidence of reactive and granulomatous lymphadenitis. The relatively smaller number of elderly patients in the present study may account for the lower frequency of malignant lesions, as neoplastic lymphadenopathy generally increases with advancing age.

A male predominance was observed in the present study, with males constituting 62.5% of the study population. Research by Doaa Alqaidy et al10 , Goyal el al11 indicated a male predominance in lymphadenopathy patients, indicating that occupational exposure may be a contributing factor. Although variations in gender distribution have been reported across different studies, this observation may reflect differences in regional demographics, occupational exposure, healthcare utilization, and the prevalence of infectious diseases rather than any inherent biological predisposition. The gender distribution is therefore likely to vary depending on the population under investigation.

Inflammatory lesions constituted 94.8% of all lymph node aspirates, making them by far the predominant diagnostic category. This finding emphasizes that most patients presenting with superficial lymphadenopathy have benign and potentially treatable conditions. FNAC serves as an effective screening investigation by rapidly distinguishing inflammatory lesions from neoplastic disorders, thereby reducing unnecessary surgical biopsies and allowing early initiation of appropriate medical treatment. This advantage is particularly valuable in tertiary care hospitals with high patient loads and in healthcare settings where access to histopathological services may be limited.

Reactive lymphadenitis emerged as the most common cytological diagnosis, accounting for more than two-thirds of all cases. Similar findings were noted by Shrivastav A et al12, Mohan AR et al13 .Reactive lymph nodes represent a physiological response to antigenic stimulation and may occur secondary to localized or systemic infections, viral illnesses, autoimmune disorders, or nonspecific inflammatory conditions. Cytologically, these lesions exhibit a polymorphous lymphoid population with preserved maturation and numerous tangible body macrophages. Since reactive hyperplasia often resolves with appropriate treatment of the underlying condition, recognition of its characteristic cytomorphological features is important to prevent unnecessary surgical intervention and patient anxiety. The predominance of reactive lymphadenitis in the present study reflects the high burden of infectious and inflammatory diseases in the community.

Acute suppurative lymphadenitis was the second most frequent diagnosis. These lesions are characterized by abundant neutrophilic infiltrates, necrotic background material, and cellular debris, findings that strongly suggest bacterial infection. FNAC not only establishes the diagnosis but may also provide material for microbiological investigations whenever required. Early diagnosis enables prompt initiation of antibiotic therapy or drainage of abscesses, thereby reducing morbidity and avoiding diagnostic excision of the lymph node.

Granulomatous lymphadenitis, including tuberculous lymphadenitis, constituted 10.4% of the cases similar to other studies by Radhakrishnan et al14(8.8%) and Mitra et al15 (14.2%). Tuberculosis remains an important public health problem in India and continues to be a common cause of peripheral lymph node enlargement. FNAC plays a pivotal role in the diagnosis of tuberculous lymphadenitis by demonstrating epithelioid granulomas, Langhans giant cells, and caseous necrosis. The addition of Ziehl–Neelsen staining for acid-fast bacilli further improves diagnostic accuracy in appropriate clinical settings.16 Early cytological diagnosis facilitates timely initiation of antitubercular therapy and minimizes delays associated with more invasive diagnostic procedures.

Only three cases were diagnosed as neoplastic lesions, accounting for 3.1% of the total study population. This relatively low frequency suggests that malignant lymphadenopathy constituted a small proportion of patients presenting with superficial lymph node enlargement during the study period. FNAC is highly effective in identifying metastatic malignancies and raising suspicion for lymphoid neoplasms; however, definitive diagnosis and subclassification of lymphoma require histopathological examination, immunohistochemistry, and, where available, flow cytometry or molecular studies. Therefore, FNAC should be regarded as an excellent screening and triage tool rather than a substitute for tissue biopsy in all malignant conditions.

The major strengths of the present study include its evaluation of consecutive FNAC cases over a two-year period and its demonstration of the wide cytomorphological spectrum of superficial lymphadenopathy encountered in routine practice. However, the study is limited by its retrospective design, relatively small sample size, and the absence of histopathological correlation for all cases. Future prospective studies incorporating clinicoradiological findings, histopathology, and ancillary techniques such as immunocytochemistry or molecular diagnostics would further strengthen the diagnostic value of FNAC.

Overall, the findings of the present study reaffirm that FNAC is a rapid, safe, reliable, and cost-effective diagnostic modality for the evaluation of superficial lymphadenopathy. It accurately differentiates inflammatory from neoplastic lesions, facilitates early therapeutic decisions, and substantially reduces the need for unnecessary surgical biopsies. Its simplicity and high diagnostic yield make it particularly valuable in outpatient practice and resource-limited healthcare settings, where timely diagnosis and appropriate patient management are of paramount importance.

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