title: Endosonography-guided fine needle aspiration cytology of intra-abdominal lymph nodes with unknown primary in a tuberculosis endemic region.
abstract: OBJECTIVE
  Intra-abdominal lymphadenopathy poses a diagnostic and management challenge in highly endemic regions for tuberculosis. Opting for empirical anti-tuberculosis treatment raises the risk of wrong or delayed treatment. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the procedure of choice for tissue acquisition from peri-luminal lymph nodes. We studied the utility of EUS-FNA in evaluating intra-abdominal lymph nodes of unknown etiology, in the setting of high endemicity of tuberculosis.
  
  
  METHODS
  Consecutive patients with intra-abdominal lymph nodes of unknown etiology underwent EUS-FNA using a 22-gauge needle. Final diagnosis was made on surgical histology or on 6-months follow-up. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic yield were calculated.
  
  
  RESULTS
  Sixty-six patients were included. Final diagnoses were tuberculosis, 35 (53%); metastatic adenocarcinoma, 11 (16.7%); lymphoma, three (4.5%); carcinoid, one (1.5%) and reactive nodes, 16 (24.2%). EUS-FNA provided a diagnosis in 61 patients (92.4%). Sensitivity, specificity, PPV and NPV for diagnosing tuberculosis via EUS-FNA were 97.1%, 100%, 100% and 96.9%, respectively. In 10 (15.2%) patients receiving empirical anti-tuberculosis treatment, the final diagnoses were metastatic adenocarcinoma (5), lymphoma (2), carcinoid (1) and reactive adenopathy (2).
  
  
  CONCLUSIONS
  Despite being in a highly endemic area, almost half of the patients studied have a non-tuberculosis etiology. EUS-FNA is a safe and accurate procedure for establishing the diagnosis of unexplained intra-abdominal lymphadenopathy.
authors.affiliation: Department of Endoscopy and Endosonography, Mumbai, India Department of Pathology, Institute of Advanced Endoscopy, Mumbai, India. vinaydhir@gmail.com
authors.forename: Vinay
authors.initials: V
authors.lastname: Dhir
authors.forename: Praveen
authors.initials: P
authors.lastname: Mathew
authors.forename: Suryaprakash
authors.initials: S
authors.lastname: Bhandari
authors.forename: Mukta
authors.initials: M
authors.lastname: Bapat
authors.forename: Andrew
authors.initials: A
authors.lastname: Kwek
authors.forename: Vatsala
authors.initials: V
authors.lastname: Doctor
authors.forename: Amit
authors.initials: A
authors.lastname: Maydeo
mesh_terms: D000005:Abdomen; D000230:Adenocarcinoma / Q000150:complications / Q000175:diagnosis / Q000556:secondary; D044963:Biopsy, Fine-Needle / Q000295:instrumentation / Q000379:methods*; D002276:Carcinoid Tumor / Q000150:complications / Q000175:diagnosis; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology*; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology*; D008207:Lymphatic Metastasis; D008223:Lymphoma / Q000150:complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D019310:Pseudolymphoma / Q000150:complications / Q000175:diagnosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*