TY  - JOUR
AU  - Kumwenda, Tapiwa
AU  - Phiri, Veronica 
AU  - Rambik, Kelvin
AU  - Sossen, Bianca
AU  - Tomoka,  Tamiwe  
AU  - Fedoriw, George  
AU  - Painschab, Mathews S.
AU  - Rambiki, Ethel 
AU  - Wallrauch, Claudia 
AU  - Heller, Tom 
TI  - Ultrasound-guided lymph node biopsies: feasible and safe use of pathology services in a resource-limited, high TB/HIV prevalence setting
PY  - %2026/%03/%04
Y2  - %2026/%08/%27
JF  - The Ultrasound Journal
JA  - Ultrasound J
VL  - 18
IS  - 1
SE  - Original Research Papers
DO  - 10.5826/tuj.2026.18321
UR  - https://doi.org/10.5826/tuj.2026.18321
SP  - 18321
AB  - 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.
ER  -