Endosonography-guided fine needle aspiration cytology of intra-abdominal lymph nodes with unknown primary in a tuberculosis endemic region

J Gastroenterol Hepatol. 2011 Dec;26(12):1721-4. doi: 10.1111/j.1440-1746.2011.06800.x.


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.

MeSH terms

  • Abdomen
  • Adenocarcinoma / complications
  • Adenocarcinoma / diagnosis
  • Adenocarcinoma / secondary
  • Biopsy, Fine-Needle / instrumentation
  • Biopsy, Fine-Needle / methods*
  • Carcinoid Tumor / complications
  • Carcinoid Tumor / diagnosis
  • Endosonography / methods*
  • Female
  • Humans
  • India / epidemiology
  • Lymph Nodes / diagnostic imaging*
  • Lymph Nodes / pathology*
  • Lymphatic Diseases / diagnostic imaging*
  • Lymphatic Diseases / etiology
  • Lymphatic Diseases / pathology*
  • Lymphatic Metastasis
  • Lymphoma / complications
  • Lymphoma / diagnosis
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Pseudolymphoma / complications
  • Pseudolymphoma / diagnosis
  • Retrospective Studies
  • Sensitivity and Specificity
  • Tuberculosis / complications
  • Tuberculosis / diagnosis
  • Tuberculosis / epidemiology*