Spectrum of lymph node lesions as per recent Sydney system of lymph node classification

Background: Lymphadenopathy may be an incidental finding and/or primary or secondary manifestation of underlying diseases which may be neoplastic or non-neoplastic. The aim of the current study was to evaluate the spectrum of lymph node lesions according to the Sydney system in our setting and to assess the risk of malignancy in each category. Methods: The present study was carried out in the Department of Pathology, Nalanda Medical College and Hospital, Patna (Bihar) retrospectively during a one-year period from November 2020 to October 2021. 332 FNACs were performed on patients and the ROM (Risk of Malignancy) was assessed for each diagnostic category. Results: In the present study, 11 cases were categorized as L1, inadequate/non-diagnostic; 291 cases as L2,benign; 06 cases as L3, AUS/ALUS; 03 as L4, Suspicious for malignancy, and finally 21 cases were categorized as L5, Malignant. The ROM was 1.28% in L2, 50% in L3, and 100% in L4,L5. ROM for L1 category could not be assessed. Conclusion: The universal implementation of the Sydney system of reporting lymph node cytopathology can improve the diagnostic accuracy which will not only instill confidence in the pathologists but also help the clinicians to adopt better management strategies. Keywords: granulomatous; lymphadenitis; lymphoma; metastases; malignancy