"My questions being-is that true?"
Yes, and all of what this new doc says is also what I've been saying to you from the start. I like this new doc :)
"I had read the FNA easily misses lymphoma..."
Well, I wouldn't agree with saying "easily". Overall accuracy is ~85%. But the accuracy might depend on different types of lymphoma.
"is it true that it would at least show indicators needing more evaluation if there were lymphomas in there?"
There could be a very small number of cases that are borderline, with cells that are abnormal under the microscope but are not quite cancer. Then a doc might order advanced testing like flow cytometry.
Btw, core needles aren't generally used much anymore, as accuracy isn't improved over FNA.
A much more complicated answer:
My thinking is that you should want the FNA to hopefully find clues as to what the real cause is -- which I believe is likely inflammatory, and not-cancer. You then have a credible alternative path to diagnosis. On the other hand, if on the small chance it shows a cancer, that is likely to be true -- that's called the "Positive Predictive Value" of a test.
However, what you have been looking for is to rule out cancer. That concerns the "Negative Predictive Value". Luckily, there is an FFT (free full text):
Diagnostic Value of Fine-Needle Aspiration in Head and Neck Lymphoma: A Cross-Sectional Study
"It was found that FNA had... a negative predictive value of 85.7%"
But if you are convinced you have cancer and want to prove it? "a sensitivity of 88%"
That paper is actually an excellent example of how important it can be to read an entire paper. That's because in your case, the abstract mostly doesn't apply to you. In the Discussion, we read:
"Our study showed a limited value for FNA in diagnosis of Hodgkin’s lymphoma. FNA could diagnose only five out of nine lymphoma cases." HL is your age group.
Also: "Since FNA could only diagnose two out of six cases with low grade malignant masses in our study, we concluded that FNA had a limited value in the diagnosis of such masses". If you have lymphoma, it is low grade (slow).
Then again, this study says that FNA works very well for HL:
"Value of fine-needle aspiration cytology in diagnosis of Hodgkin's lymphoma and anaplastic large cell lymphoma: one centre experience."
Well, one thing I was pointing out is that the evidence is contradictory, as to how accurate an FNA can be in finding either Hodgkin's or low grade non-Hodgkin's.
But I still would very much recommend the FNA. If the FNA finds inflammatory (non-cancer) cells that shouldn't ordinarily be there, then that is good evidence that your enlarged nodes are not due to cancer.
"are you saying that there is a good chance the FNA would miss signs of Hoskins or other lymphomas"
"or are you saying they are still reliable for ruling them out."
" I know it can’t nevessarily diagnose it"
Yes, it can. If the FNA finds cancer cells, then cancer is really there.
Here is the analogy that's long been used: imagine a loaf of bread in front of you. Is it plain or is it raisin bread? You can poke a few holes to try and find out. What if it is raisin bread, but by chance you miss the raisins?
"you’ve said my lymph nodes are likely fibrosis-just basic scarring with no deeper insidious meaning. However you keep saying to lol for a diagnosis. I’m confused as to whether you think I’m fine or have an underlying condition"
I mean: to look for a diagnosis as to *why* the scarring occurred. Yes, I am guessing that you have an underlying (non-cancer) condition - and it's very possible that there is one basic thing that is causing all the varied symptoms.
"with no deeper insidious meaning"
Not necessarily so. It's probably not cancer, but it still might have bad effects (that possibly get worse) for the rest of your life.
If you don't have an immune disorder, then the next possibility would be a rare genetic mutation.
Autoimmunity is just a subset of immune disorders. There are also autoinflammatory disorders. There are immune deficiency disorders. I don't recall exactly but I doubt that I have ever said that I think your problems are from autoimmunity. However, if there is immune dysfunction (as a catchall term) in the family, then generally that means you are more likely to have immune dysfunction.
"I thought you initially made it sound like fibrosis is something that happens somewhat regularly to everyone after a bad infection."
Fibrosis in nodes is not usual in people generally. Usually, nodes go back down after an infection. But for those people who have nodes that stay enlarged, the most common cause would probably be fibrosis.
No one on the planet completely understands the immune system. In a sense, we are still in the stone age for that.