ArticleThe ultrasound journal2026
Ultrasound-guided lymph node biopsies: feasible and safe use of pathology services in a resource-limited, high TB/HIV prevalence setting.
Article in The ultrasound journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundEnlarged 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).
methodsAt 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.
resultsIn 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).
conclusionUltrasound-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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