Euroasian journal of hepato-gastroenterology

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VOLUME 14 , ISSUE 1 ( January-June, 2024 ) > List of Articles

Original Article

Pancreatobiliary Lymphadenopathy: Etiology, Location, and Factors Predicting Good Yield of Endoscopic Ultrasound-guided Biopsy

Abbas Ali Tasneem, Taha Yaseen, Syed Mudassir Laeeq, Zain Majid, Nasir Hassan Luck

Keywords : Endoscopic ultrasound, Etiology, Macroscopic on-site evaluation, Pancreatobiliary lymph nodes

Citation Information : Tasneem AA, Yaseen T, Laeeq SM, Majid Z, Luck NH. Pancreatobiliary Lymphadenopathy: Etiology, Location, and Factors Predicting Good Yield of Endoscopic Ultrasound-guided Biopsy. Euroasian J Hepatogastroenterol 2024; 14 (1):40-43.

DOI: 10.5005/jp-journals-10018-1433

License: CC BY-NC 4.0

Published Online: 12-06-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Introduction: Pancreatobiliary lymphadenopathy (PBL) may be due to a number of benign or malignant causes. Tissue sampling of these lymph nodes (LN) can be possible with the help of endoscopic ultrasound (EUS). Aim of this study was to identify the etiology of the PBL, morphology, and factors predicting good yield of biopsy with EUS. Materials and methods: All patients found to have pancreatobiliary lymph node (PBLN) enlargement (>10 mm) on abdominal imaging and referred for EUS-guided biopsy were included in this prospective observational study. The facility of rapid on-site evaluation (ROSE) was not available. Adequacy of the tissue specimen was assessed by the endoscopist with macroscopic on-site evaluation (MOSE) and then sent to histopathologist for final diagnosis. Factors predicting good yield of biopsy were then analyzed. Results: Of the total 87 patients with PBL, 54 (62.1%) were males. Mean age of the patients was 52.0 (±13.4) and range 18–80 years. The commonest locations of PBL were porta hepatis 37 (42.5%), peripancreatic 24 (27.6%), celiac 16 (18.4%), and others 10 (11.5%). Histological reports showed: neoplastic tissue in 34 (39.1%), non-neoplastic in 20 (23%), normal lymphoid tissue (27.6%) and suboptimal in 9 (10.3%). Among the 34 neoplastic causes, 26 had metastatic adenocarcinoma, 5 had lymphoma, and 3 had metastatic neuroendocrine tumors. Among the 20 non-neoplastic causes, 10 had tuberculosis, 4 had anthracosis, and 6 had other findings. Factors predicting good yield of biopsy were a PBLN size ≥12 mm and satisfactory MOSE on both univariate [PBLN (p = 0.005); MOSE (p < 0.0001)] and multivariate [PBLN (p = 0.011); MOSE (p < 0.0001)] analysis. Conclusion: The commonest etiology of PBLN enlargement was metastatic adenocarcinoma among the neoplastic causes and tuberculosis among the non-neoplastic causes. The most common PBLNs approached by EUS were in portahepatis and peripancreatic regions. A good biopsy yield can be predicted with PBLN size of ≥12 mm and a satisfactory MOSE.

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  1. Wang W, Han C, Ling X, et al. Diagnostic role of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in abdominal lymphadenopathy of unknown etiology. Front Med (Lausanne). 2023;10:1221085. DOI: 10.3389/fmed.2023.1221085.
  2. de Melo SW Jr, Panjala C, Crespo S, et al. Interobserver agreement on the endosonographic features of lymph nodes in aerodigestive malignancies. Dig Dis Sci 2011;56(11):3204–3208. DOI: 10.1007/s10620-011-1725-8.
  3. Tamanini G, Cominardi A, Brighi N, et al. Endoscopic ultrasound assessment and tissue acquisition of mediastinal and abdominal lymph nodes. World J Gastrointest Oncol 2021;13(10):1475–1491. DOI: 10.4251/wjgo.v13.i10.1475.
  4. Pausawasdi N, Maipang K, Sriprayoon T, et al. Role of endoscopic ultrasound-guided fine-needle aspiration in the evaluation of abdominal lymphadenopathy of unknown etiology. Clin Endosc 2022;55(2):279–286. DOI: 10.5946/ce.2021.218-IDEN.
  5. Korenblit J, Anantharaman A, Loren DE, et al. The role of endoscopic ultrasound-guided fine needle aspiration (eus-fna) for the diagnosis of intra-abdominal lymphadenopathy of unknown origin. J Interv Gastroenterol 2012;2(4):172–176. DOI: 10.4161/jig.23742.
  6. Krishna NB, Gardner L, Collins BT, et al. Periportal lymphadenopathy in patients without identifiable pancreatobiliary or hepatic malignancy. Clin Gastroenterol Hepatol 2006;4(11):1373–1377. DOI: 10.1016/j.cgh.2006.09.002.
  7. Rao BH, Nair P, Priya SK, et al. Role of endoscopic ultrasound guided fine needle aspiration/biopsy in the evaluation of intra-abdominal lymphadenopathy due to tuberculosis. World J Gastrointest Endosc 2021;13(12):649–658. DOI: 10.4253/wjge.v13.i12.649.
  8. Wang J, Chen Q, Wu X, et al. Role of endoscopic ultrasound-guided fine-needle aspiration in evaluating mediastinal and intra-abdominal lymphadenopathies of unknown origin. Oncol Lett 2018;15(5): 6991–6999. DOI: 10.3892/ol.2018.8253.
  9. de Moura DTH, McCarty TR, Jirapinyo P, et al. Endoscopic ultrasound fine-needle aspiration versus fine-needle biopsy for lymph node diagnosis: A large multicenter comparative analysis. Clin Endosc 2020;53(5):600–610. DOI: 10.5946/ce.2019.170.
  10. Mohan BP, Madhu D, Reddy N, et al. Diagnostic accuracy of EUS-guided fine-needle biopsy sampling by macroscopic on-site evaluation: A systematic review and meta-analysis. Gastrointest Endosc 2022;96(6):909–917.e11. DOI: 10.1016/j.gie.2022.07.026.
  11. So H, Seo DW, Hwang JS, et al. Macroscopic on-site evaluation after EUS-guided fine needle biopsy may replace rapid on-site evaluation. Endosc Ultrasound 2021;10(2):111–115. DOI: 10.4103/EUS-D-20-00113.
  12. Oh D, Seo DW, Hong SM, et al. The impact of macroscopic on-site evaluation using filter paper in EUS-guided fine-needle biopsy. Endosc Ultrasound 2019;8(5):342–347. DOI: 10.4103/eus.eus_34_19.
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