Iranian Journal of Pathology

Risk Assessment of Diagnostic Categories in the Proposed Sydney System for Reporting Lymph Node Cytopathology: A Retrospective Cytomorphological Study

Document Type : Original Research

Authors

Surabhi .
Avinash Singh
Shambhawi Sharma
Tarun Kumar
Punam Prasad Bhadani
Shreekant Bharti
Ruchi Sinha

Department of Pathology, All India Institute of Medical Sciences, Patna, Bihar, India

https://doi.org/10.30699/ijp.2025.2058284.3445
Abstract
Background & Objective: Fine-needle aspiration cytology (FNAC) is a minimally invasive, rapid, and relatively safe diagnostic method for the initial evaluation of lymphadenopathy of unknown origin. In May 2020, the Sydney System was proposed to provide recommendations for diagnostic categorization, FNAC of lymphadenopathy, pathology reporting, and related practices. This study aimed to analyze the applicability of the Sydney System in lymph node FNAC and to evaluate diagnostic accuracy and risk of malignancy (ROM) for each diagnostic category.
Methods: A 2-year retrospective diagnostic study was conducted from January 2019 through December 2020. Sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy (DA), and ROM were calculated using histopathology as the gold standard.
Results: A total of 632 lymph node FNAC cases were included, with histopathological follow-up available in 45 cases. The median age of patients was 26 years, with a male-to-female ratio of 1.2:1. Cervical lymph nodes were most frequently involved (367 cases, 58.1%). Overall sensitivity, specificity, and diagnostic accuracy were 66.7%, 85.0%, and 76.3%, respectively. ROM by diagnostic category was: nondiagnostic (25%), benign (5.2%), atypia of undetermined significance (AUS) (50%), suspicious (80%), and malignant (88.8%).
Conclusion: FNAC demonstrated high diagnostic efficacy when applied using the proposed Sydney System, supporting the utility of this standardized reporting scheme for lymph node cytology.

Keywords

fine-needle aspiration
lymphadenopathy
malignancy
retrospective
diagnostic accuracy

Subjects

Copyright © 2026. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The license also allows users to adapt, remix, transform, and build upon the material for any purpose, including commercial use.

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Iranian Journal of Pathology
Volume 21, Issue 1
Winter 2026
Pages 20-28

  • Receive Date 21 April 2025
  • Revise Date 04 August 2025
  • Accept Date 03 September 2025

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