Role of endoscopic ultrasound guided fine needle aspiration/biopsy in the evaluation of intra-abdominal lymphadenopathy due to tuberculosis

doi:10.4253/wjge.v13.i12.649

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World Journal of Gastrointestinal Endoscopy

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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.

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

ARTICLE HIGHLIGHTS

Research background

Intra-abdominal lymphadenopathy due to tuberculosis (TB) poses a diagnostic challenge due to difficulty in tissue acquisition.

Research motivation

Endoscopic ultrasound guided fine needle aspiration/biopsy (EUS-FNA/B) has shown excellent results in patients with mediastinal lymphadenopathy. However, its role in the evaluation of abdominal lymphadenopathy due to TB needs further clarity.

Research objectives

The utility of EUS-FNA/B in the evaluation of intra-abdominal lymphadenopathy was assessed by evaluating the diagnostic yield in patients with confirmed TB.

Research methods

This was a single center retrospective study conducted in a large tertiary care hospital where patients with intra-abdominal lymphadenopathy referred for EUS-FNA/B were studied. The diagnosis of TB was confirmed and EUS-FNA/B results including cytology, pathological diagnosis, ancillary test findings (TB culture, GeneXpert) and demographics in these patients were carefully analyzed.

Research results

This study showed that EUS-FNA/B has a high diagnostic yield with good sensitivity (86%), specificity (93%) and diagnostic accuracy (88%) in the evaluation of intra-abdominal lymphadenopathy in patients with a clinical suspicion of TB. Morphological findings on EUS evaluation of intra-abdominal lymphadenopathy include hypoechoic/heteroechoic nodes, with sharp borders, with/without matting.

Research conclusions

EUS-FNA/B is a viable, reliable and safe procedure, which can be performed with moderate sedation and can potentially prevent further invasive testing in this subgroup of patients.

Research perspectives

This study provides vital information that can guide the approach and management of patients with intra-abdominal lymphadenopathy. A management algorithm that highlights key points during the management of these patients is provided. However, the utility of this procedure in populations with a low prevalence of TB needs more clarity. In addition, a protocol-based approach with additional tests such as TB culture, acid fast bacilli stain, TB-polymerase chain reaction or GeneXpert in specific subgroups of patients at risk for TB needs to be developed and evaluated in future studies.