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

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• 作者：Rajesh Puri ; MD¹ ; Rakhee Mangla ; MD² ; ; Mohamad Eloubeidi ; MD ; MHS ; FACG ; AGAF ; FASGE ; FACP³ ; Peter Vilmann ; MD ; DSc ; HC⁴ ; Ragesh Thandassery ; MBBS⁵ ; Randhir Sud ; MD¹
• 关键词：ACE ; angiotensin-converting enzyme ; AFB ; acid-fast bacilli ; EUS-FNA ; EUS-guided FNA ; IGNB ; image-guided needle biopsy ; TB ; tuberculosis
• 刊名：Gastrointestinal Endoscopy
• 出版年：2012
• 期刊代码：130_00165107
• 类别：med
• 出版时间：May, 2012
• 卷：75
• 期：5
• 页码：1005-1010
• 文件大小：1251 K

摘要

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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 卤 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.