Endoscopic Ultrasound-Guided Fine Needle Aspiration (FNA) Combined with Fine Needle Biopsy (FNB) in the Diagnosis and Subclassification of Deep-Seated Lymphomas - Report of a Case Series and Review of Literature

BACKGROUND Evaluation of intra-abdominal/intrathoracic lymphadenopathy in the absence of enlarged peripheral nodes has always been a challenging problem for clinicians, especially with unfavourable general conditions of the patient where surgical interventions are difficult. Endoscopic ultrasound-guided FNA has been used for the last two decades for tissue acquisition from patients with such deep-seated lesions. But its use in the diagnosis of lymphoma has always been challenging. However, the addition of fine needle core biopsy into this procedure has given promising results. In this study, we wanted to evaluate the effectiveness of EUS-FNA/FNB as an alternative to invasive open surgical procedures. METHODS We exhibit a case series of 6 patients who presented with mediastinal and/ or intraabdominal lymphadenopathy in whom EUS-FNA & FNB were done simultaneously to obtain tissue for histological and ancillary studies. RESULTS Clinically these lymph nodes were detected by CECT and there was no peripheral lymphadenopathy. In this case series, we were able to make a diagnosis of lymphoma in all 6 cases. With the help of immunohistochemistry, 2 cases were further classified into Hodgkin’s lymphoma and one case was diagnosed as ALK-positive anaplastic large cell lymphoma. All three patients underwent treatment from our hospital and are on follow-up. CONCLUSIONS Our experience with this case series report suggests that EUS-FNA/FNB is a minimally invasive procedure which can be tried effectively as an alternative to invasive open surgical procedures.