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Ultrasound-guided lymph node biopsies: feasible and safe use of pathology services in a resource-limited, high TB/HIV prevalence setting

Background

Enlarged lymph nodes (LN) pose diagnostic challenges for people with HIV (PWH).

While tuberculosis (TB) is a common cause in low-income settings, lymphomas and Kaposi’s sarcoma must also be considered.

Ultrasound and symptoms cannot distinguish between these conditions, and histology is often needed, but limited resources in low-income countries restrict sampling.

To minimize the need for excisional biopsies, we introduced an algorithm for ultrasound-guided core-needle biopsies (CNB) after negative fine-needle aspiration (FNA) results by Xpert-Ultra (Cepheid, USA).

Methods

At the Lighthouse clinic in Lilongwe, Malawi, patients with peripheral lymphadenopathy underwent an ultrasound-guided FNA.

Negative Xpert-Ultra results prompted CNB using Tru-Cut needles, with samples sent for pathology.

We retrospectively analyzed 12 months of cross-sectional data, including histology results and abdominal ultrasound findings.

Results

In 2024, 53 CNBs were performed, 96%in PWH. No significant complications were observed.

A conclusive diagnosis was reached in 77% of cases, with the most common diagnoses being hematological malignancies (54%), reactive LN (15%), Kaposi’s sarcoma (12%) and metastatic carcinoma (10%).

Infections, including granulomatous inflammation were found in 10% of cases.

Hypoechoic spleen lesions were more frequent in patients with hematological diseases (p=0.03).

Discussion

Ultrasound-guided CNB of enlarged peripheral LN is a safe, effective addition to routine ART clinics.

After negative Xpert-Ultra FNA, hematological malignancies were common.

Abdominal ultrasound findings were frequently abnormal overall and hypoechoic spleen lesions were more common in patients with hematological abnormalities.

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