A lymph node biopsy is a procedure where a sample of lymph node tissue is removed to check for signs of disease, such as infection, cancer, or immune system disorders. The procedure can involve removing part or all of a lymph node and is used to diagnose the cause of swollen lymph nodes, determine if cancer has spread, and identify other conditions. Different methods exist, including needle biopsies and open surgical biopsies.

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🧠 Definition

A lymph node biopsy is a diagnostic procedure in which part or all of a lymph node is removed for microscopic and laboratory examination.
It helps determine the cause of lymphadenopathy (enlarged lymph nodes), including infections, immune disorders, and malignancies.

🎯 Purpose / Indications

1. Diagnosis of malignancy

  • Lymphoma (Hodgkin or Non-Hodgkin)

  • Metastatic cancer (from breast, lung, melanoma, GI tract, etc.)

2. Infectious causes

  • Tuberculosis (Mycobacterium tuberculosis)

  • Toxoplasmosis

  • Fungal infections (e.g., Histoplasma, Cryptococcus)

  • Viral infections (EBV, CMV, HIV)

3. Inflammatory or autoimmune diseases

  • Sarcoidosis

  • Kikuchi disease

  • Castleman disease

  • Lupus lymphadenitis

🧫 Types of Lymph Node Biopsy

Type Description Diagnostic Yield Typical Use
Fine-Needle Aspiration (FNA) Thin needle removes small amount of cells/fluid Cytology only (no architecture) Initial screening, metastasis evaluation
Core Needle Biopsy Larger needle obtains tissue core Moderate yield When excision not feasible
Excisional Biopsy Entire lymph node removed Highest diagnostic yield Gold standard for lymphoma diagnosis
Incisional Biopsy Portion of node removed Intermediate yield For large or deep nodes

🩻 Site Selection

  • Choose the largest, most abnormal, and most accessible node.

  • Avoid inguinal and axillary nodes if possible — often show reactive hyperplasia.

  • Cervical, supraclavicular, or epitrochlear nodes often yield better diagnostic results.

⚙️ Procedure Overview

Preparation

  • Informed consent

  • Coagulation profile (PT/INR, platelet count)

  • Local anesthesia (sometimes general for deep nodes)

Technique (Excisional Biopsy)

  1. Incision made over node.

  2. Careful dissection to isolate lymph node without rupturing capsule.

  3. Complete removal of node.

  4. Specimen handling:

    • Place in formalin for histopathology.

    • Fresh portion in saline for flow cytometry, culture, or molecular studies (if lymphoma suspected).

  5. Hemostasis and closure.

Duration: 30–60 minutes (outpatient or short stay).

🔬 Laboratory Evaluation

  • Histopathology: architecture, cell morphology, necrosis, granulomas.

  • Immunohistochemistry (IHC): CD markers (e.g., CD3, CD20, CD15, CD30).

  • Flow cytometry: detects clonal B/T-cell populations (for lymphoma).

  • Microbiology: AFB stain, Gram stain, fungal stain, PCR, culture.

  • Molecular studies: gene rearrangements, translocations (e.g., BCL2, MYC).

📋 Interpretation / Common Findings

Finding Suggests
Reactive hyperplasia Benign response to infection/inflammation
Granulomatous inflammation TB, sarcoidosis, fungal infection
Caseating granulomas Tuberculosis
Reed–Sternberg cells Hodgkin lymphoma
Monomorphic lymphoid population Non-Hodgkin lymphoma
Metastatic malignant cells Secondary carcinoma or melanoma

⚠️ Complications

  • Local bleeding or hematoma

  • Infection at incision site

  • Nerve injury (esp. cervical or axillary biopsies)

  • Seroma or lymphatic leak

  • Scarring

Serious complications are rare with proper technique.

🧩 Aftercare

  • Keep incision site clean and dry.

  • Remove sutures in 7–10 days (if non-absorbable).

  • Watch for redness, swelling, discharge, or fever.

  • Resume normal activity after 24–48 hours (unless contraindicated).

🏥 Advantages & Limitations

Advantages Limitations
Definitive diagnosis of lymphoma & metastasis Invasive
Allows histology, IHC, culture, molecular tests May miss disease if non-representative node
Guides staging and treatment Requires expertise for interpretation

📚 References

  • Rosai and Ackerman’s Surgical Pathology, 12th ed.

  • WHO Classification of Tumours of Haematolymphoid Tissues (5th ed, 2022).

  • UpToDate: “Approach to lymph node biopsy for lymphoma.”

  • NCCN Guidelines for Lymphomas (2024).

Would you like me to include a diagram or step-by-step visual of how an excisional lymph node biopsy is performed?

 


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