Diagnosing Lymphoma - The Node Biopsy

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What is a lymph node biopsy?

A biopsy is a small procedure where a bit of tissue is taken from a lymph node or other part of the body which is suspected to have a tumor, and sent to the laboratory for testing and examination by a pathologist. When lymphoma is suspected, lymph nodes may be biopsied.

Why is it important to take a biopsy?

Tissue taken from the nodes can be processed in a lab, and presented to a pathologist.

The pathologist looks at this tissue under a microscope and identifies what kind of disease is present. Not all enlarged nodes have become swollen because they contain lymphoma cells and other cells that are reacting to the presence of lymphoma. Other possible causes need to be ruled out, including infection by bacteria and viruses.

How is a lymph node biopsy performed?

For diagnosing lymphomas, a biopsy usually needs to be taken from a lymph node. The procedure can be done in an outpatient surgical center or in a hospital operating room. Your doctor will choose the location on your body where he can feel enlarged lymph nodes. You will be given an injection of local anesthetic so that you don't feel any pain during the procedure. A small cut is made on the skin and a single or a few lymph nodes are taken out. The cut is stitched back. The procedure takes about 30 to 45 minutes. You can go home soon after the procedure.

You may have to stop taking any blood thinners for a week or more before the procedure, and you may be asked not to eat or drink anything before the biopsy procedure. Be sure to read any instructions given to you beforehand. If anything is unclear to you or you have further questions, ask your doctor so they can be resolved before the procedure.

Reaching nodes and tumors deep in the body:

Sometimes enlarged lymph nodes or other affected parts which need testing may be deep inside the body where a simple biopsy cannot be performed. The doctor may then take the help of a radiologist to scan the body and guide a needle to the exact portion which has the tumor to be excised. The needle can then suck out tissue which can be sent to the pathologist for testing.

Fine needle aspiration cytology (FNAC):

FNAC is a simpler procedure where a fine needle is used to suck out  (aspirate) some cells from the nodes or tissues which require testing. It hardly causes any pain, and is a quick procedure that may be done in the doctor's office.  Ultrasound may be used to guide the needle for better accuracy. But this test is not as good as a biopsy for initially diagnosing lymphoma. The aspirated cells in the FNAC cannot always tell us the exact type of lymphoma it is. For some tumors where a biopsy cannot be performed easily, this test is used to get tissue for testing.

Sources:

John A. Daller, MD. Lymph node biopsy, MedlinePlus, 8/5/2014. U.S. National Library of Medicine.

Mayo Clinic Staff. Swollen lymph nodes, Jan. 02, 2014. MayoClinic.org.

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