Diagnostic yield of EUS-guided FNA and cytology in suspected tubercular intra-abdominal lymphadenopathy

Abstract

Background: Intra-abdominal lymphadenopathy is a common diagnostic challenge faced by clinicians. In the absence of palpable peripheral nodes, tissue is usually obtained from the abdominal nodes by image-guided biopsy or surgery. We speculate that EUS-guided FNA (EUS-FNA) avoids the morbidity of a laparotomy and might be equally effective.

Objective: To evaluate the role of EUS-FNA in abdominal lymphadenopathy.

Design: Prospective study conducted over 42 months.

Setting: Tertiary care center in New Delhi, India.

Patients: Patients with abdominal lymphadenopathy in whom image-guided node biopsy failed were considered for EUS-FNA.

Intervention: A total of 3 passes were performed at each site. Slides were prepared per protocol and sent for cytopathologic evaluation.

Results: A total of 142 patients were enrolled, but only 130 (91.5%) underwent FNA. The mean lymph node size was 22 ± 3.2 mm; 71.8% of the nodes were hypoechoic (n = 102), and 28.1% were heterogeneous with an anechoic center (n = 40). In 120 patients (84.5%), the lymph nodes were intra-abdominal only, and in 22 patients (15.5%), they were both intra-abdominal and mediastinal in location.

Main outcome measurement: EUS-FNA was successful in establishing a diagnosis in 90.8% of these patients; 76.1% were found to have tuberculosis, 7.04% sarcoidosis, 6.33% Hodgkin's lymphoma, and 0.74% non-Hodgkin's lymphoma.

Limitations: In 8.4% patients, nodes were inaccessible because of their retropancreatic location.

Conclusions: EUS-FNA is a safe, accurate, and minimally invasive modality for diagnosing the cause of abdominal lymphadenopathy. In highly endemic areas, tuberculosis is the most common cause.