Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
권호 표지
DOI QR코드

DOI QR Code

Role of Endoscopic Ultrasound-Guided Fine-Needle Aspiration in the Evaluation of Abdominal Lymphadenopathy of Unknown Etiology

  • Received : 2021.08.12
  • Accepted : 2021.10.26
  • Published : 2022.03.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background/Aims: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a standard procedure for obtaining tissue from lesions near the gastrointestinal lumen. However, there is a scarcity of information on the diagnostic performance of EUS-FNA for abdominal lymphadenopathy of unknown causes. To assess the accuracy of EUS-FNA in diagnosing abdominal lymphadenopathy of unknown etiology. Methods: The EUS records of patients with undiagnosed abdominal lymphadenopathy between 2010 and 2015 were reviewed. Results: A total of 42 patients were included in this study. Adequate specimens were obtained from 40 patients (95%). The final diagnoses were metastatic cancer (n=16), lymphoma (n=9), tuberculosis (n=8), inflammatory changes (n=6), and amyloidosis (n=1). For diagnosing malignancy, EUS-FNA had a sensitivity of 84.6%, specificity of 95.7%, positive predictive value of 91.7%, negative predictive value of 91.7%, and area under the receiver operating characteristic curve (AUROC) of 0.901. For the diagnosis of lymphoma, EUS-FNA was 100% accurate when combined with cytologic evaluation and immunohistochemical staining. The diagnostic sensitivity decreased to 75%, whereas the specificity remained 100%, for tuberculosis. The overall AUROC was 0.850. No procedure-related complications occurred. Conclusions: EUS-FNA showed high diagnostic performance for abdominal lymphadenopathy of unknown causes, especially malignancy, lymphoma, and tuberculosis. Therefore, it is a crucial diagnostic tool for this patient population.

Keywords

Acknowledgement

We thank Professor Sanya Sukpanichnant, Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, for reviewing the pathologic slides and providing insightful suggestions on cytologic and pathologic assessments for lymphoma diagnosis.

References

  1. Korenblit J, Anantharaman A, Loren DE, Kowalski TE, Siddiqui AA. The role of endoscopic ultrasound-guided fine needle aspiration (EUSFNA) for the diagnosis of intra-abdominal lymphadenopathy of unknown origin. J Interv Gastroenterol 2012;2:172-176. https://doi.org/10.4161/jig.23742
  2. Torabi M, Aquino SL, Harisinghani MG. Current concepts in lymph node imaging. J Nucl Med 2004;45:1509-1518.
  3. Pongpornsup S, Eksamutchai P, Teerasamit W. Differentiating between abdominal tuberculous lymphadenopathy and lymphoma using multidetector computed tomography (MDCT). J Med Assoc Thai 2013;96:1175-1182.
  4. Dhir V, Mathew P, Bhandari S, et al. Endosonography-guided fine needle aspiration cytology of intra-abdominal lymph nodes with unknown primary in a tuberculosis endemic region. J Gastroenterol Hepatol 2011;26:1721-1724. https://doi.org/10.1111/j.1440-1746.2011.06800.x
  5. Costache M-I, Iordache S, Karstensen JG, Saftoiu A, Vilmann P. Endoscopic ultrasound-guided fine needle aspiration: from the past to the future. Endosc Ultrasound 2013;2:77-85. https://doi.org/10.4103/2303-9027.117691
  6. Wani S, Muthusamy VR, Komanduri S. EUS-guided tissue acquisition: an evidence-based approach (with videos). Gastrointest Endosc 2014;80:939-959.e7. https://doi.org/10.1016/j.gie.2014.07.066
  7. Wiersema MJ, Vilmann P, Giovannini M, Chang KJ, Wiersema LM. Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment. Gastroenterology 1997;112:1087-1095. https://doi.org/10.1016/S0016-5085(97)70164-1
  8. Nakahara O, Yamao K, Bhatia V, et al. Usefulness of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for undiagnosed intra-abdominal lymphadenopathy. J Gastroenterol 2009;44:562-567. https://doi.org/10.1007/s00535-009-0048-4
  9. Coe A, Conway J, Evans J, Goebel M, Mishra G. The yield of EUS-FNA in undiagnosed upper abdominal adenopathy is very high. J Clin Ultrasound 2013;41:210-213. https://doi.org/10.1002/jcu.22013
  10. Yasuda I, Tsurumi H, Omar S, et al. Endoscopic ultrasound-guided fine-needle aspiration biopsy for lymphadenopathy of unknown origin. Endoscopy 2006;38:919-924. https://doi.org/10.1055/s-2006-944665
  11. World Health Organization. Global tuberculosis control : surveillance, planning, financing : WHO report 2007. [Internet]. Geneva: WHO; c2007 [updated 2007; cited 2021 Dec 6]. Available from: http://catalogue.safaids.net/publications/who-report-2007-global-tuberculosis-control-surveillance-planning-financing
  12. Chen VK, Eloubeidi MA. Endoscopic ultrasound-guided fine needle aspiration is superior to lymph node echofeatures: a prospective evaluation of mediastinal and peri-intestinal lymphadenopathy. Am J Gastroenterol 2004;99:628-633. https://doi.org/10.1111/j.1572-0241.2004.04064.x
  13. Wang J, Chen Q, Wu X, Wang Y, Hou W, Cheng B. Role of endoscopic ultrasound-guided fine-needle aspiration in evaluating mediastinal and intra-abdominal lymphadenopathies of unknown origin. Oncol Lett 2018;15:6991-6999. https://doi.org/10.3892/ol.2018.8253
  14. Li C, Shuai Y, Zhou X. Endoscopic ultrasound guided fine needle aspiration for the diagnosis of intra-abdominal lymphadenopathy: a systematic review and meta-analysis. Scand J Gastroenterol 2020;55:114-122. https://doi.org/10.1080/00365521.2019.1704052