Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Dec 16, 2021; 13(12): 649-658
Published online Dec 16, 2021. doi: 10.4253/wjge.v13.i12.649
Role of endoscopic ultrasound guided fine needle aspiration/biopsy in the evaluation of intra-abdominal lymphadenopathy due to tuberculosis
Harshavardhan Rao B, Priya Nair, S Krishna Priya, Archana George Vallonthaiel, Dipu T Sathyapalan, Anoop K Koshy, Rama P Venu
Harshavardhan Rao B, Priya Nair, S Krishna Priya, Anoop K Koshy, Rama P Venu, Department of Gastroenterology, Amrita Institute of Medical Sciences, Kochi 682041, Kerala, India
Archana George Vallonthaiel, Department of Pathology, Amrita Institute of Medical Sciences, Kochi 682041, Kerala, India
Dipu T Sathyapalan, Department of Internal Medicine, Amrita Institute of Medical Sciences and Research Centre, Kochi 682041, Kerala, India
Author contributions: Priya SK helped in subject recruitment and data entry of the study; Rao B H and Nair P were involved with data analysis, interpretation and drafted the manuscript; George A and Sathyapalan DT gave initial insight related to the pathology and management of TB; Koshy AK and Venu RP revised the article critically for important intellectual content.
Institutional review board statement: This study was approved by the Amrita Institute of Medical Sciences Research Review Board (Kochi, Kerala, India).
Informed consent statement: All study participants or their legal guardian provided informed written consent for personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Anoop K Koshy, MBBS, MD, Department of Gastroenterology, Amrita Institute of Medical Sciences, AIMS Ponekkara, Kochi 682041, Kerala, India. akkoshy5@gmail.com
Received: May 26, 2021
Peer-review started: May 26, 2021
First decision: June 17, 2021
Revised: June 22, 2021
Accepted: June 28, 2021
Article in press: June 28, 2021
Published online: December 16, 2021
Processing time: 201 Days and 17 Hours
Abstract
BACKGROUND

Intra-abdominal lymphadenopathy due to tuberculosis (TB) poses a diagnostic challenge due to difficulty in tissue acquisition. Although endoscopic ultrasound guided fine needle aspiration/biopsy (EUS-FNA/B) has shown promise in the evaluation of mediastinal lymph nodes, its role in the evaluation of intra-abdominal lymphadenopathy is not clear.

AIM

To assess the role of EUS-FNA/B in the evaluation of intra-abdominal lymphadenopathy due to TB.

METHODS

This was a retrospective study where patients with intra-abdominal lymphadenopathy who underwent evaluation with EUS-FNA/B were included. TB was diagnosed if the patient had any one of the following: (1) Positive acid fast bacilli (AFB) stain/TB GeneXpert/TB-polymerase chain reaction/AFB culture of tissue sample; and (2) Positive Mantoux test and response to anti-tubercular therapy. EUS-FNA reports, clinical reports and imaging characteristics of patients were recorded for a detailed analysis of patients with TB.

RESULTS

A total of 149 patients underwent an EUS-FNA/B from lymph nodes (mean age 51 ± 17 years, M:F = 1.2). Benign inflammatory reactive changes were seen in 45 patients (30.2%), while 54 patients (36.2%) showed granulomatous inflammation with/without caseation. Among these, 51 patients (94.4%) were confirmed to have TB as per pre-defined criteria. Patients with TB were more likely to have hypoechoic and matted nodes [40 patients (67.7%)]. EUS-FNA/B was found to have a sensitivity and specificity of 86% and 93% respectively, with a diagnostic accuracy of 88% in the evaluation of intra-abdominal lymphadenopathy due to TB.

CONCLUSION

EUS-FNA/B has a high diagnostic yield with a good sensitivity and specificity in the evaluation of intra-abdominal lymphadenopathy due to TB. However, the validity of these findings in populations with low prevalence of TB needs further evaluation.

Keywords: Endoscopic ultrasound; Lymph nodes; Tuberculosis; Mesenteric; Intra-abdominal

Core Tip: Intra-abdominal lymphadenopathy due to tuberculosis (TB) poses a significant diagnostic challenge primarily due to difficulty in tissue acquisition. Endoscopic ultrasound guided fine needle aspiration/biopsy (EUS-FNA/B) has shown promise in the evaluation of TB presenting with mediastinal lymph nodes; however, its role in intra-abdominal lymphadenopathy due to TB remains unclear. In this study, a large cohort of patients who underwent EUS-FNA/B were studied. EUS-FNA/B was found to have a sensitivity and specificity of 86% and 93%, respectively, with a high diagnostic accuracy of 88% in the evaluation of intra-abdominal lymphadenitis due to TB. This study provides valuable data on the pivotal role of EUS-FNA/B in the evaluation of this difficult sub-group of patients. However, the validity of these findings in populations with low prevalence of TB needs further evaluation.