Role of Fine-Needle Aspiration Cytology in Evaluating Superficial Lymphadenopathy in a Resource-Limited Setting, Eastern Ethiopia

Background Lymphadenopathy is the enlargement of lymph nodes that can be caused by various factors, ranging from infectious to malignant. Fine-needle aspiration cytology (FNAC) is a simple, minimally invasive, and cost-effective diagnostic method for lymphadenopathy. Objective This study aimed to evaluate the cytopathological patterns and diagnostic accuracy of fine-needle aspiration in patients presenting with lymphadenopathy. Methods A retrospective, hospital-based study was conducted at Hiwot Fana Comprehensive Specialized University Hospital in Eastern Ethiopia, from January 2019 to December 2022. Patients with lymphadenopathy and FNAC were included in this study. Data were collected by extracting information from cytopathology reports. Descriptive statistics were used to describe the independent variables. Bivariable and multivariable logistic regression analyses were performed to identify factors associated with cancerous lymphadenopathy. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were assessed to evaluate the diagnostic accuracy of FNAC. Result This study included a total of 741 patients with lymph node FNAC. Of those patients, 75.9% were under the age of 30, and 53.4% were male. Cervical lymphadenopathy accounted for 528 (71.3%) of the total lymphadenopathy cases. More than half were diagnosed with tuberculous lymphadenitis (386; 52.1%), followed by reactive lymphadenopathy (226; 30.5%), lymphomas (8.9%), and secondary metastasis (6.7%). The likelihood of malignant lymphadenopathy increased with age, male sex, and involvement of two or more lymph node regions. Lymph node FNAC had an overall diagnostic accuracy of 92.06% with a sensitivity of 86.44%, specificity of 93.78%, PPV of 80.95%, and NPV of 95.77% as compared with lymph node histopathology. Conclusion FNAC remains a simple, valid, reliable, rapid, and cost-effective method for diagnosis, treatment, or indicating further diagnostic work-up in resource-limited countries, such as Ethiopia. FNAC has high diagnostic accuracy, preventing unnecessary surgical removal of lymphadenopathy for diagnosis. However, clinicopathological correlation, repeating the FNAC, or performing an incisional lymph node biopsy is recommended for enhanced efficiency.