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Endosonography‐guided fine needle aspiration cytology of intra‐abdominal lymph nodes with unknown primary in a tuberculosis endemic region
Author(s) -
Dhir Vinay,
Mathew Praveen,
Bhandari Suryaprakash,
Bapat Mukta,
Kwek Andrew,
Doctor Vatsala,
Maydeo Amit
Publication year - 2011
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.2011.06800.x
Subject(s) - medicine , tuberculosis , fine needle aspiration , radiology , etiology , lymphoma , lymph , biopsy , surgery , pathology
Background and Aim: Intra‐abdominal lymphadenopathy poses a diagnostic and management challenge in highly endemic regions for tuberculosis. Opting for empirical anti‐tuberculosis treatment raises the risk of wrong or delayed treatment. Endoscopic ultrasound‐guided fine needle aspiration (EUS‐FNA) is the procedure of choice for tissue acquisition from peri‐luminal lymph nodes. We studied the utility of EUS‐FNA in evaluating intra‐abdominal lymph nodes of unknown etiology, in the setting of high endemicity of tuberculosis. Methods: Consecutive patients with intra‐abdominal lymph nodes of unknown etiology underwent EUS‐FNA using a 22‐gauge needle. Final diagnosis was made on surgical histology or on 6‐months follow‐up. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic yield were calculated. Results: Sixty‐six patients were included. Final diagnoses were tuberculosis, 35 (53%); metastatic adenocarcinoma, 11 (16.7%); lymphoma, three (4.5%); carcinoid, one (1.5%) and reactive nodes, 16 (24.2%). EUS‐FNA provided a diagnosis in 61 patients (92.4%). Sensitivity, specificity, PPV and NPV for diagnosing tuberculosis via EUS‐FNA were 97.1%, 100%, 100% and 96.9%, respectively. In 10 (15.2%) patients receiving empirical anti‐tuberculosis treatment, the final diagnoses were metastatic adenocarcinoma (5), lymphoma (2), carcinoid (1) and reactive adenopathy (2). Conclusion: Despite being in a highly endemic area, almost half of the patients studied have a non‐tuberculosis etiology. EUS‐FNA is a safe and accurate procedure for establishing the diagnosis of unexplained intra‐abdominal lymphadenopathy.