Clin Endosc.  2022 Mar;55(2):279-286. 10.5946/ce.2021.218-IDEN.

Role of Endoscopic Ultrasound-Guided Fine-Needle Aspiration in the Evaluation of Abdominal Lymphadenopathy of Unknown Etiology

Affiliations
  • 1Siriraj GI Endoscopy Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • 2Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

Abstract

Background/Aims
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a standard procedure for obtaining tissue from lesions near the gastrointestinal lumen. However, there is a scarcity of information on the diagnostic performance of EUS-FNA for abdominal lymphadenopathy of unknown causes. To assess the accuracy of EUS-FNA in diagnosing abdominal lymphadenopathy of unknown etiology.
Methods
The EUS records of patients with undiagnosed abdominal lymphadenopathy between 2010 and 2015 were reviewed.
Results
A total of 42 patients were included in this study. Adequate specimens were obtained from 40 patients (95%). The final diagnoses were metastatic cancer (n=16), lymphoma (n=9), tuberculosis (n=8), inflammatory changes (n=6), and amyloidosis (n=1). For diagnosing malignancy, EUS-FNA had a sensitivity of 84.6%, specificity of 95.7%, positive predictive value of 91.7%, negative predictive value of 91.7%, and area under the receiver operating characteristic curve (AUROC) of 0.901. For the diagnosis of lymphoma, EUS-FNA was 100% accurate when combined with cytologic evaluation and immunohistochemical staining. The diagnostic sensitivity decreased to 75%, whereas the specificity remained 100%, for tuberculosis. The overall AUROC was 0.850. No procedure-related complications occurred.
Conclusions
EUS-FNA showed high diagnostic performance for abdominal lymphadenopathy of unknown causes, especially malignancy, lymphoma, and tuberculosis. Therefore, it is a crucial diagnostic tool for this patient population.

Keyword

Endosonography; Fine-needle aspiration; Lymphadenopathy; Lymphoma; Tuberculous lymphadenitis

Figure

  • Fig. 1. Final diagnoses of the study cohort.

  • Fig. 2. The association between endosonographic features and the diagnosis. (A) The bar graph demonstrates the association between the oval or irregular shape of lymph nodes and the diagnosis of tuberculosis or reactive changes compared to malignancy. (B) An endoscopic ultrasound image shows an irregular lymph node. (C) The bar graph demonstrates the association between the peri-hepatic lymph nodes and the diagnosis of tuberculosis. (D) An endoscopic ultrasound image shows enlarged lymph nodes located in the hilar region. (E) The bar graph shows the association between lymph nodes with regular borders and the diagnosis of lymphoma. (F) Endoscopic ultrasound image of a lymph node with a well-defined border. LAD, lymphadenopathy; LN, lymph node.

  • Fig. 3. Characteristic of specimens obtained from a patient with tuberculosis. (A) An endoscopic ultrasound image of a group of peri-hilar lymph nodes in a patient with tuberculosis. (B) Pus in the specimen obtained from fine needle aspiration of a lymph node.


Reference

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