@article{Kumwenda_Phiri_Rambik_Sossen_Tomoka_Fedoriw_Painschab_Rambiki_Wallrauch_Heller_2026, place={Fidenza (PR), Italy}, title={Ultrasound-guided lymph node biopsies: feasible and safe use of pathology services in a resource-limited, high TB/HIV prevalence setting}, volume={18}, url={https://mattioli1885journals.com/index.php/theultrasoundjournal/article/view/18321}, DOI={10.5826/tuj.2026.18321}, abstractNote={
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). Conclusion: 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.
}, number={1}, journal={The Ultrasound Journal}, author={Kumwenda, Tapiwa and Phiri, Veronica and Rambik, Kelvin and Sossen, Bianca and Tomoka, Tamiwe and Fedoriw, George and Painschab, Mathews S. and Rambiki, Ethel and Wallrauch, Claudia and Heller, Tom}, year={2026}, month={Mar.}, pages={18321} }