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On Sep 2018




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Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
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On Sep 2018




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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Lucknow
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On Aug 2018




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Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

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Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


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In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
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Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2010 | Month : June | Volume : 4 | Issue : 3 | Page : 2452 - 2457 Full Version

Fine Needle Aspiration Cytology (FNAC) As A Diagnostic Tool In Pediatric Lymphadenopathy


Published: June 1, 2010 | DOI: https://doi.org/10.7860/JCDR/2010/.759
DHINGRA V *, MISRA V **, MISHRA R***, BHATIA R****, SINGHAL M*****

*(M.D).Pathology,LECTURER **(M.D.)Pathology, PROFESSOR AND HEAD ***(M.D.) Pathology, PROFESSOR AND HEAD# ****(M.D.) Pathology, RESIDENT *****(M.D.)Pathology, RESIDENT *,**,****,*****Department of Pathology, M.L.N. Medical College, Allahabad, U.P. 211001(India). ***Department of Pathology, B.R.D. Medical College, Gorakhpur, U.P. (India).

Correspondence Address :
Dr. Vishal Dhingra , (M.D.)
Lecturer,
Department of Pathology,
M.L.N. Medical College,
Allahabad, U.P.
India. PIN CODE: 211001
e-mail : vishaldhingra9@yahoo.com
Ph No. : +919005180981. +915322460160
Fax No: +915322256274

Abstract

ntroduction: Lymphadenopathy is one of the commonest clinical presentations among paediatric patients, having several aetiologies and can pose as a diagnostic dilemma to a paediatrician. Therefore, it is necessary to arrive at a definitive diagnosis in order to administer proper treatment. The objective of this study was to evaluate the diagnostic role of fine needle aspiration cytology in lymphadenopathy in the paediatric age group.
Material and Methods: This study was carried out in patients up to 14 years of age, who had palpable lymph node masses. The duration of this study was 3 years. A total number of 270 cases were included in the study for cytological examination. Histopathological examination was performed in 90 patients. Both dry and wet fixed smears were prepared in all cases and were stained by MGG and Papanicolaou stains.
Results: Overall, inflammatory lymphadenopathy comprised 88.5% of the total lesions of the lymph nodes; it included 56% cases of reactive hyperplasia, 28.1% cases of granulomatous lymphadenitis and 4.4% cases of acute nonspecific lymphadenitis. Malignant lesions were seen in 11.5% patients. Overall, the diagnostic accuracy of the cytological examination was 98.89% and the overall sensitivity and specificity were 91.3% and 99.1%, respectively.
Conclusions: Fine needle aspiration cytology is a reliable, easy and economical technique in the diagnosis of paediatric lymphadenopathy.

Keywords

: Fine needle aspiration cytology, FNAC, paediatric, children, lymphadenopathy.

Lymphadenopathy is one of the commonest clinical presentations among paediatric patients attending the outdoor department. It has several aetiologies ranging from an inflammatory process to a malignant condition, thus posing diagnostic dilemma to a paediatrician. Therefore, it is necessary to arrive at a definitive diagnosis in order to administer proper treatment. FNAC is a very simple and expeditious procedure which can be carried out with ease in children (1). The objective of this study was to evaluate the diagnostic role of fine needle aspiration cytology in lymphadenopathy in the paediatric age group. It has been shown in several studies like ours, that FNA is fairly accurate in the diagnosis of lymphadenopathy (2),(3). In the last few years, FNAC has emerged as a reliable diagnostic procedure in the paediatric age group, thus obviating the need for excision biopsy (4),(5).

Material and Methods

The study was carried out in patients up to 14 years of age, who had palpable lymph node masses. Lymphadenopathy was considered to be significant if the cervical group was >1.0cm and the inguinal group was >1.5cm. The patients were selected from the OPD and the wards. The duration of the study was three years. In all these patients, a thorough work out was done, which included taking detailed clinical history and general, local and systemic examination, along with routine and special investigations which included X-ray chest (PA view), bone marrow aspiration, ultrasound and CT scan (if indicated). Two hundred and eighty eight patients were subjected to FNAC; however, in 18 cases (6.25%), the material was inadequatefor cytological examination and they were excluded from the study. Only 270 cases were available for the study. Histopathological examination was performed in 90 patients. Both dry and wet fixed smears were prepared in all cases and were stained by MGG and Papanicolaou stains. Ziehl-Neelsen’s stain was used wherever indicated.

Results

In this study, 153 patients were males and 117 patients were females. The male and female ratio was 1.30:1.

The maximum number of cases were in the age group of 7-14 years (156 cases, 57.8%), followed by 84 (31.2%) and 30 cases (11%) in the range of 2-6 and 0-1 years, respectively.

The sites of distribution of the enlarged lymph nodes were divided into generalised and localised. Generalised lymphadenopathy was defined as the enlargement of more than two non-contiguous node regions (6). In the present study, localised lymphadenopathy was seen in 243 cases (90%) and the generalised category was seen in 27 cases (10 %.) . The maximum number of cases had cervical lymphadenopathy (79%), followed by involvement of the axillary (11%) and the inguinal (10%) nodes. Out of the cervical group of nodes, the upper anterior and the upper posterior deep cervical nodes were involved in a majority of cases (68.0%). The size of the nodes was measured in all the cases. The largest node which was seen had a maximum diameter of 5.5 cm. .

The diagnosis of 270 cases of lymphadenopathy based on cytological examination alone is shown in (Table/Fig 1). However, Cytohistological correlation could be done in 90 cases only, as shown in (Table/Fig 2).The cytological criteria which were adopted for classification were as follows:

(Table/Fig 1) Diagnosis of 270 cases of lymphadenopathy based on cytological examination

(Table/Fig 2) Cytohistological correlation of the 90 cases

Inflammatory Lesions
Two hundred and thirty nine nodes were diagnosed as inflammatory by FNAC. They were further grouped into three sub-categories.

Reactive Hyperplasia
The cytosmears of these cases showed a mixed population of lymphoid cells. The cytological pattern of distribution of the cells depended on whether the follicular or intrafollicular tissue was aspirated. Thus, smears from a node containing cells of the active germinal centre had many centrocytes and centroblasts, while mature lymphocytes, plasma cells and immunoblasts were relatively sparse (Table/Fig 3) (Figure 3A) Smears which had cells of the interfollicular tissue were predominantly mature lymphocytes, plasma cells and immunoblasts.They were probably from cases of lymphadenopathy following viral infection. These cases were grouped as non-specific hyperplasia.

Besides these cells, smears of reactive hyperplasia showed numerous macrophages. In some of them, the cytoplasm contained introcytoplasmic nuclear debris (tingible body macrophage). The background of these smears also showed cytoplasmic fragments ,known as lymphoglandular bodies (Table/Fig 3). (Figure 3B)




(Table/Fig 3) (A): Aspiration smear showing polymorphic population of lymphoid cells in a case of reactive lymphadenitis (MGG, 100x)

(Table/Fig 3) (B): Aspiration smear showing polymorphic population of lymphoid cells in a case of reactive lymphadenitis (MGG, 400x)

(Table/Fig 3) (C): Aspiration smear showing cluster of epithelioid cells in a case of granulomatous lymphadenitis (MGG, 400x)

(Table/Fig 3) (D): Aspiration smear showing Langhan’s Giant Cell in a case of granulomatous lymphadenitis (MGG, 100x)

Out of the 49 cases diagnosed by cytology, 48 were confirmed by histopathology andone case turned out to be non Hodgkin’s lymphoma instead of reactive hyperplasia

Granulomatous Lymphadenitis
Out of the 76 cases which were diagnosed as granulomatous lymphadenitis, 51 cases showed epithelioid granuloma with caseous material and 25 cases had epithelioid granuloma without caseous material. Epithelioid cells with the characteristic curved elongated nuclei with indistinct cytoplasm were usually seen in clusters (Table/Fig 3) (Figure 3C). Occasionally, (five cases) Langhan’s multinucleated giant cells were seen (Table/Fig 3) (Figure 3D). Caseous material was eosinophilic and granular and lacked recognizable cell remnants. Some cases presented with secondary infection and in them, a course of antibiotics was advised and repeat FNAC was done. In those cases in which only caseous material was seen, repeat FNAC was advised to search for a granuloma. In all these cases, cytological smears were stained with Ziehl Neelsen’s stain for Acid Fast Bacilli (AFB) and only 7% cases proved to be positive. Though granulomatous response is seen in a wide variety of infectious agents and non infectious processes (both benign and malignant), as tuberculosis is so common in our country, every clinically relevant case of granulomatous lymphadenitis should be considered as tuberculous lymphadenitis, unless proved otherwise (7). We had correlated all our cases of granulomatous lymphadenitis with the clinical presentation, Montoux test, AFB, culture, PCR and their response to Anti Tubercular Agents.

Out of 26 cases which were diagnosed by cytology, 25 were confirmed by histopathology. One case where the diagnosis of tuberculosis was made on the basis of epithelioid cells, turned out to be Hodgkin’s lymphoma by histopathology.

Acute Suppurative
The cytosmears showed degenerated and viable inflammatory cells, predominantly polymorphs. Repeat aspiration was advised after a course of antibiotic therapy.

Malignant Lesions
Non-Hodgkin’s Lymphoma
Monotonous population i.e. single cell type predominating the smear, was the most important basis for the diagnosis of non-Hodgkin’s lymphoma in cytological smears (Table/Fig 4) (Figure 4A and 4B) In this study, five cases were diagnosed correctly by FNAC. One case diagnosed by us as reactive hyperplasia turned out to be non-Hodgkin’s lymphoma. Conversely, one case which we diagnosed as non-Hodgkin’s lymphoma was reactive hyperplasia.

Hodgkin’s Lymphoma
The presence of Reed Sternberg cells was essential to diagnose Hodgkin’s lymphoma. In all our cases, Reed Sternberg cells were seen in the cytosmears (Table/Fig 4) (Figure 4C) Numerous atypical large mononuclear cells with prominent nucleoli were also seen. Besides these cells, variable numbers of plasma cells, lymphocytes, eosinophils and reactive cells were seen in the background.
In the present study, two cases were diagnosed as Hodgkin’s lymphoma byFNAC and both were confirmed by histology (Table/Fig 4) (Figure 4D) One case which was misdiagnosed as tuberculosis by FNAC was actually Hodgkin’s lymphoma.



(Table/Fig 4) (A) : Aspiration smear from Non Hodgkin’s lymphoma, showing monomorphic population of lymphoid cells (Pap, 100x)

(Table/Fig 4) (B) : Aspiration smear from Non Hodgkin’s lymphoma, showing monomorphic population of lymphoid cells (MGG, 400x)

(Table/Fig 4) (C): Aspiration smear Hodgkin’s lymphoma, showing single Reed Stenberg cell (Pap, 400x)

(Table/Fig 4) (D): Paraffin section of lymph node. Hodgkin’s lymphoma, nodular sclerosis, showing lacunar cells (H&E, 100x)

Leukaemic Infiltrate
Four cases of acute lymphoblastic leukaemia which were diagnosed by GBP and bone marrow examination presented with lymphadenopathy; however, only two cases were confirmed by histopathology. Cytosmears of all these cases showed lymphoblasts which were similar to those which were found by GBP and bone marrow examination and were diagnosed as leukaemic infiltrates.

In the present study, we found the overall diagnostic accuracy of the cytosmears to be 98.89% and the overall sensitivity and the specificity to be 91.3% and 99.1%, respectively.

Discussion

This study was carried out primarily to evaluate the role of FNAC as a diagnostic tool, with it’s advantages and limitations, in paediatric lymphadenopathy. In the present study, cytological examination was done on 270 patients, but histopathological examination of the lymph nodes could be done only in 90 patients.

Overall, inflammatory lymphadenopathy comprised 88.5% of the total lesions of the lymph nodes; it included 56% cases of reactive hyperplasia, 28.1% cases of tubercular lymphadenitis and 4.4% cases of acute nonspecific lymphadenitis. Malignant lesions were seen in 11.5% of the patients. These findings are in agreement of those reported by Locham et al, who diagnosed reactive hyperplasia in 68% cases, tubercular lymphadenopathy in 29% cases and malignancy in 3% cases (8). Tripathi et al found reactive hyperplasia in 64% cases and tuberculosis and neoplasia in 4% of the patients (9). Sankaran et al also observed lymphoid hyperplasia as the most common condition in benign lesions, followed by tuberculosis (10) .Jain et al reported 1.8% malignant cases in their study (11). The present finding of 11.5 % is much higher than those reported by the above workers; this could probably be because of relatively more referral of the suspected cases of lymphoma to our centre.

The maximum number of cases (79%) in the present study involved the cervical group of lymph nodes. This could be attributed to the predominant population reporting to our centre being from the low socio-economic group.As they have a high incidence of oropharyngeal, dental and scalp infections which results in enlargement of the cervical lymph nodes, draining the above regions and manifesting with reactive lymphadenitis.

Hemalatha et al and Sen et al showed a higher incidence of tuberculosis in the cervical group of lymph nodes, followed by the axillary group (12),(13). Kumar et al stated that the cervical group of lymph nodes were mainly involved in the cases of tuberculosis in children, whereas the cervical and the axillary types were both involved in adults (14). The present findings are in agreement with the above studies.

In the present study, it was noticed that a maximum number of cases; 243 out of 270 (90.0%) presented with localized lymph node enlargement as compared to 10% which presented with generalised lymphadenopathy. These observations are similar to the findings of Gupta et al (15). On further break-up in their work, they found that the maximum number of their cases of lymphoma presented with generalized lymphadenopathy. Similarly, in our study, we also found that 17 out of 31 (55%) cases of lymphoma presented with generalized lymphadenopathy.

The overall sensitivity and specificity reported by Prasad et al were 89.2% and 100%, respectively, which matched with our findings (16).

As far as the diagnosis of tubercular lymphadenitis was concerned, the diagnostic accuracy of the cytosmears in the present study was 98.89%, which was similar to that reported by Singh et al and Patra et al (17),(18). The specificity of 98.4% in this study matched with that of Sankaran et al.

The sensitivity of the cytosmears in the cases of Hodgkin’s disease in this study was 66.6%. Sankaran et al reported the sensitivity in his work as 30%, which is lower as compared to this study. The specificity of 100% in the present study is at par with that of Sankaran et al i.e. 98.6%.

In cases of non-Hodgkin’s lymphoma, the diagnostic accuracy in the present study was 97.78%, which was slightly higher than that reported by Gupta et al. The sensitivity of 97.95% in the cases of non-Hodgkin’s lymphoma in the present study is higher as compared to 80.3% which was observed by Sankaran et al, whereas the observed specificity of 98.80% in cases of non-Hodgkin’s lymphoma is in agreement with the findings of Sankaran et al i.e. 95.4%. Jain et al reported a diagnostic accuracy of 100% in malignant lymphadenopathy in children.

Overall, the diagnostic accuracy of the cytosmears was 98.89% and the overall sensitivity and specificity were 91.3% and 99.1%, respectively. These findings are in agreement with the findings of Godvin et al and Frable et al. (19), (20)

Thus, fine needle aspiration cytology is a reliable, easy and economical technique with a high diagnostic accuracy; but it is not 100% accurate. Many lymph node diseases may require the confirmation of cytodiagnosis by histopathological examination.

With the increasing costs of medical facilities, any technique which speeds up the process of diagnosis, limits the physical and the psychological trauma to the patient and saves the expenditure of hospitalization, is of tremendous value. FNAC also helps the surgeon to select, guide and modify treatment planning in patients who require surgery. It reduces the necessity to perform excision biopsy in many cases, thus saving children from surgical complications. Thus, FNAC can be recommended as a first line of investigation in the diagnosis of lymphadenopathy in the paediatric age group.

Key Message

• FNAC is a very simple and expeditious procedure which can be carried out with ease in children.
• FNAC is fairly accurate in the diagnosis of lymphadenopathy
• It reduces the necessity to perform excision biopsy in many cases, thus saving children from surgical complications.

References

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Twist CJ, Link MP. Assessment of lymphadenopathy in children. Pediatr Clin N Am 2002; 49: 1009-25
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Byun JC, Choe BK, Hwang JB, Kim HS, Lee SS. Diagnostic effectiveness of fine needle aspiration cytology on pediatric cervical lymphadenopathy. Korean J Pediatr 2006;49:162-6.
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Chu EW, Hoye RC. The clinician and the cytopathologist evaluate fine needle aspiration cytology. Acta cytological.,1973; 21:413-17.
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Handa U, Mohan. H, Bal .A. Role of fine needle aspiration cytology in evaluation of paediatric lymphadenopathy. Cytopathology. 2003 :14; 66 – 69
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Ajmal F, Imran A. Comparison of FNAC vs excision biopsy for suspected tuberculous cervical lymphadenopathy. Annals King Edward med coll 2003; 9:216-8.
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Bedros AA, Mann JP. Lymphadenopathy in children. Adv Pediatr 1981;28:341– 76.
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Sankaran V, Prasad RR, Narasimhan R, Veliath AJ. Fine needle aspiration cytology in the diagnosis of superficial lymphadenopathy. An analysis of 2,418 cases. Diagn cytopathol. 1996; 15 : 382-16.
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Jain M, Majumdar DD, Agarwal K, Bais AS, Chaudhary M. Fine Needle Aspiration Cytology as a diagnostic tool in pediatric head and neck lesions. Indian Pediatrics. 1999; 36: 921-23.
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Hemalatha AN, Kumar BKA, Manjunath YA and Sreelatha R. Tuberculous lymphadenitis in a Hospital of Banglore. NTI Bulletin. 1997; 33 : 9-10.
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Sen R, Marwah N, Gupta KB, Marwah S, Arora R and Jain K. Cytomorphological patterns in Tuberculosis Lymphadenitis. Ind J Tub. 1999; 46: 125-27.
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Kumar KR. Tuberculous lymphadenitis in children. Role of Fine needle aspiration cytology. JAPI. 1999; 47 : 976-79.
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Gupta AK, Nayar M, Chandra M. Reliability and Limitations of Fine Needle aspiration cytology of lymphadenopathies. Acta cytologica. 1991; 35: 777-83.
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Prasad R, Garg SK, Mukherji PK, Agarwal PK. Role of Fine needle aspiration cytology in the diagnosis of lymphadenopathy. Indian J Chest Dis Allied Sci. 1993; 35: 27-9.
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Singh UR, Bhatia A, Deepjyoti V et al. Cytologic Diagnosis of Tuberculous lymphadenitis in children by fine needle aspiration. Ind J Ped. 1992; 59: 115-18.
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Patra A K, Nanda BK, Mohapatra BK. and Panda AK: Diagnosis of lymphadenopathy by fine needle aspiration cytology. Ind. J. Pathol. & Microbiol, 26:273-278, 1983.
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Godwin JT. Cytology diagnosis of aspiration biopsies of solid or cystic tumors. Symposium on diagnostic accuracy of cytologic techniques. Acta Cytol. 1964; 8: 206.
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Frable WJ, Kardis TF. Fine needle aspiration in the diagnosis of lymphoproliferative disease. Am J Surg Pathol. 1998; 12: 62-72.

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