Tuberculosis is still the most Common Cause of Mediastinal and Intra-abdominal Lymphadenopathy by EUS-FNA in India

Manas Kumar Behera; Jimmy Narayan; Shobhit Agarwal; Debakanta Mishra; Pruthvi Reddy; Ayaskanta Singh; Girish Kumar Pati; Manoj Kumar Sahu

doi:10.1055/s-0041-1739965

Journal of Digestive Endoscopy, Table of Contents

CC BY-NC-ND 4.0 · Journal of Digestive Endoscopy 2021; 12(03): 133-137
DOI: 10.1055/s-0041-1739965

Research Article

Tuberculosis is still the most Common Cause of Mediastinal and Intra-abdominal Lymphadenopathy by EUS-FNA in India

Authors

Manas Kumar Behera

¹Department of Hepatology, SCB Medical College, Cuttack, Orrisa, India
Jimmy Narayan

²Department of Gastroenterology, Institute of Medical Sciences & SUM Hospital, Siksha O Anusandhan Deemed to be University, K8, Kalinganagar, Bhubaneswar, Orissa, India
Shobhit Agarwal

²Department of Gastroenterology, Institute of Medical Sciences & SUM Hospital, Siksha O Anusandhan Deemed to be University, K8, Kalinganagar, Bhubaneswar, Orissa, India
Debakanta Mishra

²Department of Gastroenterology, Institute of Medical Sciences & SUM Hospital, Siksha O Anusandhan Deemed to be University, K8, Kalinganagar, Bhubaneswar, Orissa, India
Pruthvi Reddy

²Department of Gastroenterology, Institute of Medical Sciences & SUM Hospital, Siksha O Anusandhan Deemed to be University, K8, Kalinganagar, Bhubaneswar, Orissa, India
Ayaskanta Singh

²Department of Gastroenterology, Institute of Medical Sciences & SUM Hospital, Siksha O Anusandhan Deemed to be University, K8, Kalinganagar, Bhubaneswar, Orissa, India
Girish Kumar Pati

²Department of Gastroenterology, Institute of Medical Sciences & SUM Hospital, Siksha O Anusandhan Deemed to be University, K8, Kalinganagar, Bhubaneswar, Orissa, India
Manoj Kumar Sahu

²Department of Gastroenterology, Institute of Medical Sciences & SUM Hospital, Siksha O Anusandhan Deemed to be University, K8, Kalinganagar, Bhubaneswar, Orissa, India

Abstract

Background Lymph nodal tuberculosis is reported to occur in 4% to 7% of all tuberculosis, and mediastinal lymphadenopathy accounts for 10% of lymph nodal tuberculosis but the diagnosis still remains a challenge due to inaccessibility to these sites. There is a scarcity of recent data from India about the etiology of intra-abdominal and mediastinal lymphadenopathy despite being frequently detected in cross-sectional imaging.

Methods A retrospective study was conducted after reviewing hospital records over a period of 3 years from December 2017 to December 2020 who underwent endoscopic ultrasonography (EUS). A total of 126 patients with mediastinal and/or intra-abdominal lymphadenopathy detected by cross-sectional imaging were examined for clinical features, EUS, and histopathology records.

Results The mean age of patients was 53.12 ± 14.15 years. Seventy-one patients (56%) had intra-abdominal lymph nodes and 55 (44%) had mediastinal lymph nodes. The average number of needle passes was 2.35 ± 0.58 (range: 2–4). The majority of patients had tubercular etiology (53.2%) followed by metastatic (26.2%). Other etiologies were reactive (4.8%), lymphoma (4.8%), sarcoidosis (3.2%), and GIST (1.6%). No diagnosis could be ascertained in 6.3% of patients. The EUS features that favored tubercular etiology over metastatic were heterogeneous echotexture (72% vs. 30%), irregular shape (78% vs. 12%), indistinct borders (81% vs. 30%) and calcification (43% vs. 15%). Partial anechoic area and hyperechoic area were seen in 21% and 64% of tubercular patients, respectively. EUS only had sensitivity and specificity of 63% and 84%, respectively, and EUS FNA had a very high sensitivity and specificity of 93% and 100%, respectively.

Conclusion Tuberculosis is still the most common cause of lymph nodes. EUS FNA had a very high sensitivity and specificity of 93% and 100%, respectively, for the diagnosis of mediastinal and intra-abdominal lymphadenopathy.

Keywords

tuberculosis - EUS - lymph nodes

Full Text

References

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