{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T17:51:11Z","timestamp":1772646671761,"version":"3.50.1"},"reference-count":78,"publisher":"Mattioli1885","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>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\u2019s 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\u2019s 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.<\/jats:p>","DOI":"10.5826\/tuj.2026.18321","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T14:58:25Z","timestamp":1772636305000},"page":"18321","source":"Crossref","is-referenced-by-count":0,"title":["Ultrasound-guided lymph node biopsies: feasible and safe use of pathology services in a resource-limited, high TB\/HIV prevalence setting"],"prefix":"10.5826","volume":"18","author":[{"given":"Tapiwa","family":"Kumwenda","sequence":"first","affiliation":[{"name":"Lighthouse Clinic Trust, Lilongwe, Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Veronica","family":"Phiri","sequence":"additional","affiliation":[{"name":"Lighthouse Clinic Trust, Lilongwe, Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelvin","family":"Rambik","sequence":"additional","affiliation":[{"name":"Lighthouse Clinic Trust, Lilongwe, Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bianca","family":"Sossen","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tamiwe","family":"Tomoka","sequence":"additional","affiliation":[{"name":"Pathology Lab, University of North Carolina School of Medicine, Lilongwe, Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George","family":"Fedoriw","sequence":"additional","affiliation":[{"name":"Department of Pathology and Lab Medicine, University of North Carolina School of Medicine, Chapel Hill, USA; Institute for Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mathews S.","family":"Painschab","sequence":"additional","affiliation":[{"name":"Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA; UNC Project Malawi, Lilongwe, Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ethel","family":"Rambiki","sequence":"additional","affiliation":[{"name":"Lighthouse Clinic Trust, Lilongwe, Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Wallrauch","sequence":"additional","affiliation":[{"name":"Lighthouse Clinic Trust, Lilongwe, Malawi; Institute of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, LMU Munich, Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tom","family":"Heller","sequence":"additional","affiliation":[{"name":"Lighthouse Clinic Trust, Lilongwe, Malawi; International Training and Education Center for Health, University of Washington, Seattle, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"27750","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"key":"10.5826\/tuj.2026.18321_ref2","unstructured":"1 Barr DA, Lewis JM, Feasey N, et al. 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Letters to the Editor Low Rates of Side Effects in"},{"key":"10.5826\/tuj.2026.18321_ref23","unstructured":"Paclitaxel Chemotherapy for Kaposi Sarcoma and Feasibility of Treatment in Outpatient"},{"key":"10.5826\/tuj.2026.18321_ref24","unstructured":"ART Clinic Settings in Malawi. J Acquir Immune Defic Syndr 2024; 96: e1\u20132."},{"key":"10.5826\/tuj.2026.18321_ref25","unstructured":"9 Chinula L, Moses A, Gopal S. HIV-associated malignancies in sub-Saharan Africa: progress,"},{"key":"10.5826\/tuj.2026.18321_ref26","doi-asserted-by":"crossref","unstructured":"challenges, and opportunities. Curr Opin HIV AIDS 2017; 12: 89\u201395.","DOI":"10.1097\/COH.0000000000000329"},{"key":"10.5826\/tuj.2026.18321_ref27","unstructured":"10 Chalya PL, Mbunda F, Rambau PF, et al. Kaposi\u2019s sarcoma: a 10-year experience with"},{"key":"10.5826\/tuj.2026.18321_ref28","doi-asserted-by":"crossref","unstructured":"248 patients at a single tertiary care hospital in Tanzania. 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WHO consolidated guidelines on tuberculosis. Module 3:"},{"key":"10.5826\/tuj.2026.18321_ref48","unstructured":"diagnosis. 2025."},{"key":"10.5826\/tuj.2026.18321_ref49","unstructured":"18 Kohli M, Schiller I, Dendukuri N, et al. Xpert MTB\/RIF Ultra and Xpert MTB\/RIF assays 380"},{"key":"10.5826\/tuj.2026.18321_ref50","unstructured":"for extrapulmonary tuberculosis and rifampicin resistance in adults. Cochrane Database"},{"key":"10.5826\/tuj.2026.18321_ref51","doi-asserted-by":"crossref","unstructured":"Syst Rev 2021; 2021. DOI:10.1002\/14651858.CD012768.pub3.","DOI":"10.1002\/14651858.CD012768.pub3"},{"key":"10.5826\/tuj.2026.18321_ref53","unstructured":"19 Heller T, Wallrauch C, Goblirsch S, Brunetti E. Focused assessment with sonography"},{"key":"10.5826\/tuj.2026.18321_ref54","unstructured":"for HIV-associated tuberculosis (FASH): a short protocol and a pictorial review. Crit"},{"key":"10.5826\/tuj.2026.18321_ref55","unstructured":"Ultrasound J 2012; 4: 21."},{"key":"10.5826\/tuj.2026.18321_ref57","unstructured":"20 Lighthouse Group, Phiri S, Neuhann F, et al. The path from a volunteer initiative to"},{"key":"10.5826\/tuj.2026.18321_ref58","unstructured":"an established institution: evaluating 15 years of the development and contribution of the"},{"key":"10.5826\/tuj.2026.18321_ref59","unstructured":"Lighthouse trust to the Malawian HIV response. BMC Health Serv Res 2017; 17: 54."},{"key":"10.5826\/tuj.2026.18321_ref60","unstructured":"21 Gopal S, Krysiak R, Liomba NG, et al. Early Experience after Developing a Pathology"},{"key":"10.5826\/tuj.2026.18321_ref61","doi-asserted-by":"crossref","unstructured":"Laboratory in Malawi, with Emphasis on Cancer Diagnoses. PLoS ONE 2013; 8: e70361.","DOI":"10.1371\/journal.pone.0070361"},{"key":"10.5826\/tuj.2026.18321_ref63","unstructured":"22 Montgomery ND, Liomba NG, Kampani C, et al. Accurate Real-Time Diagnosis of"},{"key":"10.5826\/tuj.2026.18321_ref64","unstructured":"Lymphoproliferative Disorders in Malawi Through Clinicopathologic Teleconferences: A"},{"key":"10.5826\/tuj.2026.18321_ref65","doi-asserted-by":"crossref","unstructured":"Model for Pathology Services in Sub-Saharan Africa. Am J Clin Pathol 2016; 146: 423\u201330.","DOI":"10.1093\/ajcp\/aqw118"},{"key":"10.5826\/tuj.2026.18321_ref66","unstructured":"23 Brownlee AJ, Dewey M, Chagomerana MB, et al. Update on pathology laboratory"},{"key":"10.5826\/tuj.2026.18321_ref67","unstructured":"development and research in advancing regional cancer care in Malawi. Front Med 2024;"},{"key":"10.5826\/tuj.2026.18321_ref68","doi-asserted-by":"crossref","unstructured":"11. DOI:10.3389\/fmed.2024.1336861.","DOI":"10.3389\/fmed.2024.1336861"},{"key":"10.5826\/tuj.2026.18321_ref70","unstructured":"24 Antel K, Oosthuizen J, Malherbe F, et al. 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Clin"},{"key":"10.5826\/tuj.2026.18321_ref78","unstructured":"Microbiol Infect 2024; 30: 320\u20137."},{"key":"10.5826\/tuj.2026.18321_ref79","unstructured":"27 Bhatia K, Sahdev A, Reznek RH. Lymphoma of the Spleen. Semin Ultrasound CT MRI"},{"key":"10.5826\/tuj.2026.18321_ref80","unstructured":"2007; 28: 12\u201320."},{"key":"10.5826\/tuj.2026.18321_ref81","unstructured":"28 Adams EC, Antel K, Bailey JL, et al. Diagnostic use of abdominal ultrasound in"},{"key":"10.5826\/tuj.2026.18321_ref82","unstructured":"detecting extrapulmonary tuberculosis or lymphoma in an HIV-endemic region. South Afr J"},{"key":"10.5826\/tuj.2026.18321_ref83","doi-asserted-by":"crossref","unstructured":"HIV Med 2025; 26. DOI:10.4102\/sajhivmed.v26i1.1679.","DOI":"10.4102\/sajhivmed.v26i1.1679"},{"key":"10.5826\/tuj.2026.18321_ref84","unstructured":"29 Freitag B, Sultanli A, Grilli M, et al. Clinically Diagnosed Tuberculosis and Mortality in"},{"key":"10.5826\/tuj.2026.18321_ref85","unstructured":"High Burden Settings: A Systematic Review and Meta-Analysis. eClinicalMedicine 2025."},{"key":"10.5826\/tuj.2026.18321_ref86","doi-asserted-by":"crossref","unstructured":"DOI:10.2139\/ssrn.5091666.","DOI":"10.2139\/ssrn.5091666"},{"key":"10.5826\/tuj.2026.18321_ref87","unstructured":"30 Huson MAM, Kumwenda T, Gumulira J, Rambiki E, Wallrauch C, Heller T. Ultrasound"},{"key":"10.5826\/tuj.2026.18321_ref88","unstructured":"findings in Kaposi sarcoma patients: overlapping sonographic features with disseminated"},{"key":"10.5826\/tuj.2026.18321_ref89","unstructured":"tuberculosis. 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