From the Franzen-KIFA Handle up to Digital Cytopathology: The Long Story of Lymph Node Fine-Needle Aspiration Cytology.

BACKGROUND: Lymph node fine-needle aspiration cytology (FNAC) has a history spanning more than a century, reflecting advances in cytology, pathology, and related technical disciplines. Lymph nodes were among the earliest targets of FNAC, which is now used to diagnose a broad spectrum of pathological processes, ranging from reactive conditions to lymphomas and metastases.

SUMMARY: To address these diverse settings, nearly all ancillary techniques used in pathology practice have been applied to lymph node FNAC, with their use tailored to the pathological process, the quality and quantity of diagnostic material, and the clinical context. Over time, this evolution has also led to the development of different technical procedures, diagnostic algorithms, and classification systems. Despite its achievements and potential, lymph node FNAC is still not universally accepted and remains subject to skepticism among some clinicians and criticism from some pathologists. In many aspects, lymph node FNAC represents a paradigm of clinical cytology, and its history reflects both the period in which it evolved and the environments in which it has been practiced. This review retraces the development of lymph node FNAC from the dawn of cytopathology to the present, highlighting its major advances, current role, and future perspectives.

KEY MESSAGES: Lymph node FNAC has evolved into a versatile diagnostic tool for reactive, neoplastic, and metastatic lymph node lesions. The integration of ancillary techniques, technical innovations, and standardized classification systems has substantially expanded its diagnostic capabilities. Understanding the historical evolution of lymph node FNAC provides insight into its current role, ongoing limitations, and future perspectives in modern cytopathology.