Endoscopic ultrasound-guided fine needle biopsy in the diagnostic work-up of thoraco-abdominal lymphadenopathies: a monocentric experience

Background: Endoscopic Ultrasound (EUS) guided transluminal biopsy has transformed the diagnostic approach for patients with enlarged lymph nodes (LNs) in the mediastinum, para-aortic, and hilar regions, which previously required more invasive surgical procedures. This study conducted in Sri Lanka demonstrates the efficacy of EUS in obtaining histological samples from these anatomically challenging sites.
Materials and Methods: A retrospective study was conducted from a prospectively maintaining data base on 27 patients with lymph node (LN) masses requiring EUS-guided biopsy over a six-year period from 2018 to 2024 at a tertiary care center. All procedures were performed by a single endoscopist (ANR).
Results: The mean age was 49.4 years (SD ±15.5), of whom 16 (59.3%) were male. The distribution of lymph node (LN) locations was as follows: 11 (40.7%) para-aortic, 5 (18.5%) at the porta hepatis, 4 (14.8%) mediastinal, 4 (14.8%) coeliac, and 3 (11.1%) para-esophageal. LN sizes ranged from 10 to 47 mm. A definitive diagnosis was obtained in the majority (n=21, 77.8%), while 6 cases remained inconclusive. Among the confirmed diagnoses, 11 (52.4%) were malignant. The specific diagnoses included 4 (19.0%) cases of adenocarcinoma, 3 (14.3%) Hodgkin lymphoma, 2 (9.5%) non-Hodgkin lymphoma and 2 (9.5%) poorly differentiated carcinomas. 03 biopsies were positive for TB. Neither morbidity nor mortality were reported during the procedure.
Conclusions: EUS-guided biopsy is a safe and effective diagnostic tool for LN masses accessible via the upper gastrointestinal tract, providing a non-invasive alternative to surgical methods.