Differential Diagnosis of Periportal Adenopathy Based on Endoscopic Ultrasound Guided Fine Needle Aspiration (EUS-FNA)

Abstract

Abstract Introduction/Objective Endoscopic ultrasound guided fine-needle aspiration is a safe and accurate diagnostic procedure for abdominal lymphadenopathy. Goal of this study is to evaluate the utility of EUS-FNA in two groups of patients with periportal lymphadenopathy: group 1 with diagnosis of malignancy and group 2 with no known malignant diagnosis. Methods/Case Report This is a retrospective study of 74 patients in our database with enlarged periportal lymph nodes detected on cross sectional imaging of the abdomen. All patients underwent EUS-FNA with 22-gauge needle. Three passes were performed for each lymph node detected. Median size of periportal lymph nodes was 19.8 mm (ranging from 5 to 59 mm). 2 groups were compared: group 1 with known malignancy and group 2 with no known malignancy. All patients were clinically followed 6-12month from the procedure. Results (if a Case Study enter NA) 25 of the 74 (34%) patients had malignant diagnosis. The types of neoplasia detected were lymphoma (3), metastatic adenocarcinoma (16), metastatic acinar cell carcinoma (1) and metastatic neuroendocrine tumor (5). 42 of 74 patients (57%) had negative fine-needle aspiration diagnosis: 40 patients had reactive lymph node diagnosis, 2 patients had granulomatous inflammation diagnosis. 2(1%) of 74 cases had atypical diagnosis, 5(7%) cases were unsatisfactory due to inadequate material obtained during procedure. Sensitivity of the procedure is 45.8% and, specificity is 100%. Positive predictive value (PPV) is 100% and negative predictive value (NPV) is 78.7%. EUS-FNA can detect positive lymph nodes as small as 1 cm, however, this method can also miss positive lymph nodes up to size of 3.5 cm which probably due to the uneven involving of the nodes by tumor cells. Lymph nodes 3.5cm and larger are more likely to be malignant, however in differential diagnosis of small lymph nodes (1 cm in length) they were noT statistically significant difference between the pathologic and benign lymph nodes. Conclusion EUS-FNA is effective method for investigating periportal lymphadenopathy with known or unknown malignancy.