title: Endoscopic ultrasound characteristics of tubercular lymphadenopathy in comparison to reactive lymph nodes.
abstract: OBJECTIVE
  Tuberculosis is a common disease in India with significant morbidity and mortality. Limited data is available on the description of tubercular lymphadenopathy on endoscopic ultrasound.
  
  
  METHODS
  Retrospective data of 116 lymph nodes in 113 patients was evaluated at a tertiary care center. Lymphadenopathy in the mediastinum and abdomen were included. The study was aimed at identifying the endoscopic ultrasound (EUS) features of tubercular lymphadenopathy and comparing them with reactive lymphadenopathy in patients with pyrexia of unknown origin.
  
  
  RESULTS
  The following features were suggestive of tubercular lymphadenopathy (n = 55) as compared to reactive lymphadenopathy (n = 61): hypoechoic echotexture (94.5% vs. 75.4%, p 0.004), patchy anechoic/hypoechoic areas (30.2% vs. 0%, p = 0.000), calcification (24.5% vs. 0%, p = 0.000), sharply demarcated borders (34.5% vs. 9.8%, p = 0.001), pus like material on aspirate (18.2% vs. 0%, p 0.000), and conglomeration of lymph nodes (10.9% vs. 0%, p = 0.009). The tubercular lymph nodes were significantly larger than reactive nodes at long axis and short axis diameter (2.4 ± 1.1 vs. 1.6 ± 0.6 cm, p < 0.001 and 1.5 ± 0.7 vs. 0.9 ± 0.3 cm, p = 0.001 respectively). On cytopathological examination, presence of necrosis (92.7% vs. 0%, p = 0.000) and granulomas (78.1% vs. 0%, p = 0.000) favored tubercular as compared to reactive lymphadenopathy.
  
  
  CONCLUSIONS
  EUS features like hypoechoic echotexture, patchy anechoic/hypoechoic areas, calcification, sharply demarcated borders, conglomeration, purulent aspirate, larger size, and cytopathological presence of necrosis/granulomas are suggestive of tubercular as compared to reactive lymphadenopathy.
authors.affiliation: Institute of Digestive and Hepatobiliary Sciences, Gurgaon, Haryana, 122 001, India.
authors.forename: Vijay
authors.initials: V
authors.lastname: Bodh
authors.affiliation: Institute of Digestive and Hepatobiliary Sciences, Gurgaon, Haryana, 122 001, India.
authors.forename: Narendra S
authors.initials: NS
authors.lastname: Choudhary
authors.affiliation: Institute of Digestive and Hepatobiliary Sciences, Gurgaon, Haryana, 122 001, India. purirajesh69@gmail.com.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Puri
authors.affiliation: Institute of Digestive and Hepatobiliary Sciences, Gurgaon, Haryana, 122 001, India.
authors.forename: Naveen
authors.initials: N
authors.lastname: Kumar
authors.affiliation: Institute of Digestive and Hepatobiliary Sciences, Gurgaon, Haryana, 122 001, India.
authors.forename: Rahul
authors.initials: R
authors.lastname: Rai
authors.affiliation: Institute of Digestive and Hepatobiliary Sciences, Gurgaon, Haryana, 122 001, India.
authors.forename: Mukesh
authors.initials: M
authors.lastname: Nasa
authors.affiliation: Institute of Digestive and Hepatobiliary Sciences, Gurgaon, Haryana, 122 001, India.
authors.forename: Rajiv Ranjan
authors.initials: RR
authors.lastname: Singh
authors.affiliation: Department of Cytopathology, Medanta-The Medicity, Sector 38, Near Rajiv Chowk, CH Baktawar Singh Road, Gurgaon, Haryana, 122 001, India.
authors.forename: Haimanti
authors.initials: H
authors.lastname: Sarin
authors.affiliation: Department of Cytopathology, Medanta-The Medicity, Sector 38, Near Rajiv Chowk, CH Baktawar Singh Road, Gurgaon, Haryana, 122 001, India.
authors.forename: Mridula
authors.initials: M
authors.lastname: Guleria
authors.affiliation: Institute of Digestive and Hepatobiliary Sciences, Gurgaon, Haryana, 122 001, India.
authors.forename: Randhir
authors.initials: R
authors.lastname: Sud
mesh_terms: D000328:Adult; D000368:Aged; D019160:Endosonography / Q000379:methods; D005260:Female; D005335:Fever of Unknown Origin / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D019310:Pseudolymphoma / Q000000981:diagnostic imaging* / Q000473:pathology; D012189:Retrospective Studies; D014376:Tuberculosis / Q000000981:diagnostic imaging* / Q000473:pathology
keywords: Endoscopic ultrasound; Pyrexia of unknown origin; Tubercular lymphadenopathy