title: Diagnostic yield of EUS-guided FNA and cytology in suspected tubercular intra-abdominal lymphadenopathy.
abstract: BACKGROUND
  Intra-abdominal lymphadenopathy is a common diagnostic challenge faced by clinicians. In the absence of palpable peripheral nodes, tissue is usually obtained from the abdominal nodes by image-guided biopsy or surgery. We speculate that EUS-guided FNA (EUS-FNA) avoids the morbidity of a laparotomy and might be equally effective.
  
  
  OBJECTIVE
  To evaluate the role of EUS-FNA in abdominal lymphadenopathy.
  
  
  METHODS
  Prospective study conducted over 42 months.
  
  
  METHODS
  Tertiary care center in New Delhi, India.
  
  
  METHODS
  Patients with abdominal lymphadenopathy in whom image-guided node biopsy failed were considered for EUS-FNA.
  
  
  METHODS
  A total of 3 passes were performed at each site. Slides were prepared per protocol and sent for cytopathologic evaluation.
  
  
  RESULTS
  A total of 142 patients were enrolled, but only 130 (91.5%) underwent FNA. The mean lymph node size was 22 ± 3.2 mm; 71.8% of the nodes were hypoechoic (n = 102), and 28.1% were heterogeneous with an anechoic center (n = 40). In 120 patients (84.5%), the lymph nodes were intra-abdominal only, and in 22 patients (15.5%), they were both intra-abdominal and mediastinal in location.
  
  
  METHODS
  EUS-FNA was successful in establishing a diagnosis in 90.8% of these patients; 76.1% were found to have tuberculosis, 7.04% sarcoidosis, 6.33% Hodgkin's lymphoma, and 0.74% non-Hodgkin's lymphoma.
  
  
  CONCLUSIONS
  In 8.4% patients, nodes were inaccessible because of their retropancreatic location.
  
  
  CONCLUSIONS
  EUS-FNA is a safe, accurate, and minimally invasive modality for diagnosing the cause of abdominal lymphadenopathy. In highly endemic areas, tuberculosis is the most common cause.
authors.affiliation: Institute of Digestive and Hepatobiliary Sciences, Medanta - The Medicity, Gurgaon, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Puri
authors.forename: Rakhee
authors.initials: R
authors.lastname: Mangla
authors.forename: Mohamad
authors.initials: M
authors.lastname: Eloubeidi
authors.forename: Peter
authors.initials: P
authors.lastname: Vilmann
authors.forename: Ragesh
authors.initials: R
authors.lastname: Thandassery
authors.forename: Randhir
authors.initials: R
authors.lastname: Sud
mesh_terms: D000005:Abdomen; D000293:Adolescent; D000328:Adult; D044963:Biopsy, Fine-Needle; D019160:Endosonography; D005260:Female; D006689:Hodgkin Disease / Q000150:complications / Q000473:pathology; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology*; D008228:Lymphoma, Non-Hodgkin / Q000150:complications / Q000473:pathology; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D012507:Sarcoidosis / Q000150:complications / Q000473:pathology; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000473:pathology*; D018084:Ultrasonography, Interventional; D055815:Young Adult