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

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 abou...

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Autores principales:	Manas Kumar Behera, Jimmy Narayan, Shobhit Agarwal, Debakanta Mishra, Pruthvi Reddy, Ayaskanta Singh, Girish Kumar Pati, Manoj Kumar Sahu
Formato:	article
Lenguaje:	EN
Publicado:	Thieme Medical and Scientific Publishers Pvt. Ltd. 2021
Materias:	tuberculosis eus lymph nodes Diseases of the digestive system. Gastroenterology RC799-869
Acceso en línea:	https://doaj.org/article/04c8d11cb4f84570bcbf4a82be272426
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spelling	oai:doaj.org-article:04c8d11cb4f84570bcbf4a82be2724262021-11-25T01:57:13ZTuberculosis is still the most Common Cause of Mediastinal and Intra-abdominal Lymphadenopathy by EUS-FNA in India0976-50420976-505010.1055/s-0041-1739965https://doaj.org/article/04c8d11cb4f84570bcbf4a82be2724262021-09-01T00:00:00Zhttp://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1739965https://doaj.org/toc/0976-5042https://doaj.org/toc/0976-5050Background 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.Manas Kumar BeheraJimmy NarayanShobhit AgarwalDebakanta MishraPruthvi ReddyAyaskanta SinghGirish Kumar PatiManoj Kumar SahuThieme Medical and Scientific Publishers Pvt. Ltd.articletuberculosiseuslymph nodesDiseases of the digestive system. GastroenterologyRC799-869ENJournal of Digestive Endoscopy, Vol 12, Iss 03, Pp 133-137 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	tuberculosis eus lymph nodes Diseases of the digestive system. Gastroenterology RC799-869
spellingShingle	tuberculosis eus lymph nodes Diseases of the digestive system. Gastroenterology RC799-869 Manas Kumar Behera Jimmy Narayan Shobhit Agarwal Debakanta Mishra Pruthvi Reddy Ayaskanta Singh Girish Kumar Pati Manoj Kumar Sahu Tuberculosis is still the most Common Cause of Mediastinal and Intra-abdominal Lymphadenopathy by EUS-FNA in India
description	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.
format	article
author	Manas Kumar Behera Jimmy Narayan Shobhit Agarwal Debakanta Mishra Pruthvi Reddy Ayaskanta Singh Girish Kumar Pati Manoj Kumar Sahu
author_facet	Manas Kumar Behera Jimmy Narayan Shobhit Agarwal Debakanta Mishra Pruthvi Reddy Ayaskanta Singh Girish Kumar Pati Manoj Kumar Sahu
author_sort	Manas Kumar Behera
title	Tuberculosis is still the most Common Cause of Mediastinal and Intra-abdominal Lymphadenopathy by EUS-FNA in India
title_short	Tuberculosis is still the most Common Cause of Mediastinal and Intra-abdominal Lymphadenopathy by EUS-FNA in India
title_full	Tuberculosis is still the most Common Cause of Mediastinal and Intra-abdominal Lymphadenopathy by EUS-FNA in India
title_fullStr	Tuberculosis is still the most Common Cause of Mediastinal and Intra-abdominal Lymphadenopathy by EUS-FNA in India
title_full_unstemmed	Tuberculosis is still the most Common Cause of Mediastinal and Intra-abdominal Lymphadenopathy by EUS-FNA in India
title_sort	tuberculosis is still the most common cause of mediastinal and intra-abdominal lymphadenopathy by eus-fna in india
publisher	Thieme Medical and Scientific Publishers Pvt. Ltd.
publishDate	2021
url	https://doaj.org/article/04c8d11cb4f84570bcbf4a82be272426
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Tuberculosis is still the most Common Cause of Mediastinal and Intra-abdominal Lymphadenopathy by EUS-FNA in India

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