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

IF 0.4 Q4 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Endoscopy Pub Date : 2021-09-01 DOI:10.1055/s-0041-1739965

M. Behera, Jimmy Narayan, Shobhit Agarwal, Debakanta Mishra, P. Reddy, Ayaskanta Singh, G. Pati, M. Sahu

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引用次数: 1

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.

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在印度，通过EUS-FNA，结核病仍然是纵隔和腹腔淋巴结病的最常见原因

背景淋巴结结核占所有结核的4%至7%，纵隔淋巴结病占淋巴结结核的10%，但由于无法到达这些部位，诊断仍然是一个挑战。尽管在横断面成像中经常发现，但印度关于腹腔内和纵隔淋巴结病病因的最新数据很少。方法回顾性研究2017年12月至2020年12月3年来接受内镜超声检查的患者的住院记录。共有126名纵隔和/或腹内淋巴结病患者通过横断面成像检查了临床特征、EUS和组织病理学记录。结果患者平均年龄为53.12±14.15岁。71名患者（56%）有腹腔内淋巴结，55名患者（44%）有纵隔淋巴结。平均针数为2.35±0.58（范围：2-4）。大多数患者有结核病因（53.2%），其次是转移性病因（26.2%）。其他病因有反应性病因（4.8%）、淋巴瘤病因（4.8%）、结节病病因（3.2%）和GIST病因（1.6%）。6.3%的患者无法确定诊断。与转移性相比，有利于结核病因的EUS特征是不均匀回声结构（72%对30%）、不规则形状（78%对12%）、边界模糊（81%对30%）和钙化（43%对15%）。结核病人的局部无回声区和高回声区分别为21%和64%。EUS的敏感性和特异性分别为63%和84%，EUS-FNA的敏感性和特异度分别为93%和100%。结论肺结核仍是淋巴结最常见的病因。EUS-FNA对纵隔和腹腔淋巴结病的诊断具有非常高的敏感性和特异性，分别为93%和100%。

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来源期刊

Journal of Digestive Endoscopy GASTROENTEROLOGY & HEPATOLOGY-

自引率

28.60%

发文量

审稿时长

22 weeks

期刊介绍： The Journal of Digestive Endoscopy (JDE) is the official publication of the Society of Gastrointestinal Endoscopy of India that has over 1500 members. The society comprises of several key clinicians in this field from different parts of the country and has key international speakers in its advisory board. JDE is a double-blinded peer-reviewed, print and online journal publishing quarterly. It focuses on original investigations, reviews, case reports and clinical images as well as key investigations including but not limited to cholangiopancreatography, fluoroscopy, capsule endoscopy etc.