The role of fine-needle aspiration cytology in children with persistent orsuspicious lymphadenopathy

Purpose: The aim of this study was (1) To determine the value of fine-needl e aspiration cytology (FNAC) in children with persistent or suspicious peri pheral lymphadenopathy and (2) to analyze whether a history of previous mal ignancy influenced the accuracy of FNAC. Methods: A retrospective study in an Academic Children's Hospital of 73 FNA Cs of peripheral lymph nodes in 64 patients (35 boys and 29 girls; median a ge, 9 years; range, 15 months to 20 years) was performed between 1992 and 1 997. Eleven patients were excluded because aspirated material appeared inad equate. Outcome was compared with results of subsequent surgical biopsies, clinical follow-up, or both. Patients were divided into group A "de novo" l ymphadenopathy (n = 39) and group B lymphadenopathy and a history of previo us malignancy (n = 23). Results: Group A: FNAC showed a benign diagnosis in 25 cases, a malignancy in 13, and was inconclusive in 1. Outcome was false-negative in 2 and false -positive in 1. Sensitivity and specificity were 86% and 96%, respectively. FNAC helped avoid additional surgical procedures in 27 cases (61%). Howeve r, if FNAC showed malignant lymphoma, open biopsy was inevitable (8 of 13) to establish proper classification. Group B: FNAC showed a benign diagnosis in 10 cases and a malignancy in 13. Outcome was false-negative in 1, and f alse-positive in 1. Sensitivity and specificity were 92% and 90%, respectiv ely. FNAC helped avoid additional surgical diagnostic procedures in 25 case s (86%). Conclusions: (1) Fine-needle aspiration cytology is a rapid, simple and acc urate diagnostic procedure to differentiate between benign and malignant pe ripheral lymphadenopathy in children. FNAC can avoid open biopsy in at leas t 60% of cases. (2) A history of previous malignant disease does not influe nce the accuracy of the rest. J Pediatr Surg 36:7-17. Copyright (C) 2001 by W.B. Saunders Company.