Lymph node biopsy

Last updated
Lymph node biopsy
ICD-9-CM 40.11
MedlinePlus 003933
LOINC 66112-4

Lymph node biopsy is a test in which a lymph node or a piece of a lymph node is removed for examination under a microscope (see: biopsy).

Contents

The lymphatic system is made up of several lymph nodes connected by lymph vessels. The nodes produce white blood cells (lymphocytes) that fight infections. When an infection is present, the lymph nodes swell, produce more white blood cells, and attempt to trap the organisms that are causing the infection. The lymph nodes also try to trap cancer cells.[ citation needed ]

Imaging studies include CXR, CT scans of Abdomen,chest, pelvis, neck and PET scans.[ citation needed ]

CBC, ESR, serum ferritin, bone marrow aspiration.

Indications

The test is used to help determine the cause of lymph node enlargement (swollen glands or lymphadenitis). It may also determine whether tumors in the lymph node are cancerous or noncancerous. Enlarged lymph nodes may be caused by a number of conditions, ranging from very mild infections to serious malignancies. Benign conditions can often be distinguished from cancerous and infectious processes by microscopic examination. The pathologist may also perform additional tests on the lymph node tissue to assist in making a diagnosis.[ citation needed ]

Some of the conditions where abnormal values are obtained are:[ citation needed ]

Lymph node biopsies may be performed to evaluate the spread of cancer. See Lymphadenectomy#With sentinel node biopsy.

However, Sentinel lymph node biopsy for evaluating early, thin melanoma has not been shown to improve survival, and for this reason, should not be performed. [1] Patients with melanoma in situ, T1a melanoma or T1b melanoma ≤ 0.5mm have a low risk of cancer spreading to lymph nodes and high 5-year survival rates, so this kind of biopsy is unnecessary. [1]

Procedure

The test is done in an operating room in a hospital, or at an outpatient surgical facility. There are two ways the sample may be obtained:[ citation needed ]

Needle biopsy

A needle biopsy involves inserting a needle into a node to obtain the sample.[ citation needed ]

The patient lies on the examination table; the biopsy site is cleansed; and a local anesthetic is injected. The biopsy needle is then inserted into the node. A sample is removed, pressure is applied to the site to stop the bleeding, and a bandage is applied.

Open biopsy

An open biopsy consists of surgically removing all or part of a node.[ citation needed ]

The patient lies on the examination table and is given a sedative. The skin over the biopsy site is cleansed, and a local anesthetic is injected (occasionally, a general anesthetic is given). A small incision is made, and the lymph node or part of the node is removed. The incision is then closed with stitches and bandaged.[ citation needed ]

The sample is then sent to pathology.

With this test there is a small chance of infection or bleeding. Additionally, there is a moderate risk of nerve injury, localized paralysis, or numbness when the biopsy is performed on a lymph node close to nerves.

Related Research Articles

<span class="mw-page-title-main">Melanocytic nevus</span> Medical condition

A melanocytic nevus is usually a noncancerous condition of pigment-producing skin cells. It is a type of melanocytic tumor that contains nevus cells. Some sources equate the term mole with "melanocytic nevus", but there are also sources that equate the term mole with any nevus form.

<span class="mw-page-title-main">Cytopathology</span> A branch of pathology that studies and diagnoses diseases on the cellular level

Cytopathology is a branch of pathology that studies and diagnoses diseases on the cellular level. The discipline was founded by George Nicolas Papanicolaou in 1928. Cytopathology is generally used on samples of free cells or tissue fragments, in contrast to histopathology, which studies whole tissues. Cytopathology is frequently, less precisely, called "cytology", which means "the study of cells".

<span class="mw-page-title-main">Biopsy</span> Medical test involving extraction of sample cells or tissues for examination

A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist. The process involves extraction of sample cells or tissues for examination to determine the presence or extent of a disease. The tissue is then fixed, dehydrated, embedded, sectioned, stained and mounted before it is generally examined under a microscope by a pathologist; it may also be analyzed chemically. When an entire lump or suspicious area is removed, the procedure is called an excisional biopsy. An incisional biopsy or core biopsy samples a portion of the abnormal tissue without attempting to remove the entire lesion or tumor. When a sample of tissue or fluid is removed with a needle in such a way that cells are removed without preserving the histological architecture of the tissue cells, the procedure is called a needle aspiration biopsy. Biopsies are most commonly performed for insight into possible cancerous or inflammatory conditions.

<span class="mw-page-title-main">Mycobacterial cervical lymphadenitis</span> Human medical condition

The disease mycobacterial cervical lymphadenitis, also known as scrofula and historically as king's evil, involves a lymphadenitis of the cervical lymph nodes associated with tuberculosis as well as nontuberculous (atypical) mycobacteria.

<span class="mw-page-title-main">Melanoma</span> Cancer originating in melanocytes

Melanoma, also redundantly known as malignant melanoma, is a type of cancer that develops from the pigment-producing cells known as melanocytes. Melanomas typically occur in the skin, but may rarely occur in the mouth, intestines, or eye. In women, they most commonly occur on the legs, while in men, they most commonly occur on the back. About 25% of melanomas develop from moles. Changes in a mole that can indicate melanoma include an increase in size, irregular edges, change in color, itchiness, or skin breakdown.

<span class="mw-page-title-main">Lymphadenopathy</span> Disease of lymph nodes

Lymphadenopathy or adenopathy is a disease of the lymph nodes, in which they are abnormal in size or consistency. Lymphadenopathy of an inflammatory type is lymphadenitis, producing swollen or enlarged lymph nodes. In clinical practice, the distinction between lymphadenopathy and lymphadenitis is rarely made and the words are usually treated as synonymous. Inflammation of the lymphatic vessels is known as lymphangitis. Infectious lymphadenitis affecting lymph nodes in the neck is often called scrofula.

Cancer staging is the process of determining the extent to which a cancer has grown and spread. A number from I to IV is assigned, with I being an isolated cancer and IV being a cancer that has metastasized and spread from its origin. The stage generally takes into account the size of a tumor, whether it has invaded adjacent organs, how many regional (nearby) lymph nodes it has spread to, and whether it has appeared in more distant locations (metastasized).

Ann Arbor staging is the staging system for lymphomas, both in Hodgkin's lymphoma and non-Hodgkin lymphoma. It was initially developed for Hodgkin's, but has some use in NHL. It has roughly the same function as TNM staging in solid tumors.

<span class="mw-page-title-main">Bone marrow examination</span> Form of pathologic analysis

Bone marrow examination refers to the pathologic analysis of samples of bone marrow obtained by bone marrow biopsy and bone marrow aspiration. Bone marrow examination is used in the diagnosis of a number of conditions, including leukemia, multiple myeloma, lymphoma, anemia, and pancytopenia. The bone marrow produces the cellular elements of the blood, including platelets, red blood cells and white blood cells. While much information can be gleaned by testing the blood itself, it is sometimes necessary to examine the source of the blood cells in the bone marrow to obtain more information on hematopoiesis; this is the role of bone marrow aspiration and biopsy.

<span class="mw-page-title-main">Merkel-cell carcinoma</span> Rare and highly aggressive skin cancer

Merkel-cell carcinoma (MCC) is a rare and aggressive skin cancer occurring in about three people per million members of the population. It is also known as cutaneous APUDoma, primary neuroendocrine carcinoma of the skin, primary small cell carcinoma of the skin, and trabecular carcinoma of the skin. Factors involved in the development of MCC include the Merkel cell polyomavirus, a weakened immune system, and exposure to ultraviolet radiation. Merkel-cell carcinoma usually arises on the head, neck, and extremities, as well as in the perianal region and on the eyelid. It is more common in people over sixty years old, Caucasian people, and males. MCC is less common in children.

<span class="mw-page-title-main">B-cell lymphoma</span> Blood cancer that affects B-type white blood cells

The B-cell lymphomas are types of lymphoma affecting B cells. Lymphomas are "blood cancers" in the lymph nodes. They develop more frequently in older adults and in immunocompromised individuals.

<span class="mw-page-title-main">Vulvar cancer</span> Cancer involving the vulva

Vulvar cancer is a cancer of the vulva, the outer portion of the female genitals. It most commonly affects the labia majora. Less often, the labia minora, clitoris, or Bartholin's glands are affected. Symptoms include a lump, itchiness, changes in the skin, or bleeding from the vulva.

<span class="mw-page-title-main">Laboratory specimen</span> Biological specimen sampled from an organisms tissue, bodily fluid, or other materials

In medicine, a laboratory specimen is a biological specimen of a medical patient's tissue, fluids, or other material used for laboratory analysis to assist in differential diagnosis or staging of a disease process. These specimens are often the most reliable method of diagnosis, depending on the ailment. For example, breast cancer biopsies, performed on laboratory specimens of breast tissue, yield just a 2% rate of incorrect diagnosis.

<span class="mw-page-title-main">Skin biopsy</span> Removal of skin cells for medical examination

Skin biopsy is a biopsy technique in which a skin lesion is removed to be sent to a pathologist to render a microscopic diagnosis. It is usually done under local anesthetic in a physician's office, and results are often available in 4 to 10 days. It is commonly performed by dermatologists. Skin biopsies are also done by family physicians, internists, surgeons, and other specialties. However, performed incorrectly, and without appropriate clinical information, a pathologist's interpretation of a skin biopsy can be severely limited, and therefore doctors and patients may forgo traditional biopsy techniques and instead choose Mohs surgery.

<span class="mw-page-title-main">Lung nodule</span> Medical condition

A lung nodule or pulmonary nodule is a relatively small focal density in the lung. A solitary pulmonary nodule (SPN) or coin lesion, is a mass in the lung smaller than three centimeters in diameter. A pulmonary micronodule has a diameter of less than three millimetres. There may also be multiple nodules.

Lymphatic disease is a class of disorders which directly affect the components of the lymphatic system.

<span class="mw-page-title-main">Cervical lymphadenopathy</span> Disease of the lymph nodes

Cervical lymphadenopathy refers to lymphadenopathy of the cervical lymph nodes. The term lymphadenopathy strictly speaking refers to disease of the lymph nodes, though it is often used to describe the enlargement of the lymph nodes. Similarly, the term lymphadenitis refers to inflammation of a lymph node, but often it is used as a synonym of lymphadenopathy.

<span class="mw-page-title-main">Axillary lymphadenopathy</span> Medical condition

Axillary lymphadenopathy is distinguished by an increase in volume or changes in the morphology of the axillary lymph nodes. It can be detected through palpation during a physical examination or through changes in imaging tests. On a mammogram (MMG), normal lymph nodes typically appear oval or reniform with a radiolucent center representing hilar fat. The cortex is usually hypoechoic or even imperceptible on ultrasound imaging, whereas the medulla is hyperechoic. When a lymph node is damaged, whether by benign or malignant disease, it changes shape and structure, resulting in different patterns in imaging tests.

<span class="mw-page-title-main">Dermatopathic lymphadenopathy</span> Medical condition

In pathology, dermatopathic lymphadenopathy, is lymph node pathology due to skin disease.

CP-GEP is a non-invasive prediction model for cutaneous melanoma patients that combines clinicopathologic (CP) variables with gene expression profiling (GEP). CP-GEP is able to identify cutaneous melanoma patients at low-risk for nodal metastasis who may forgo the sentinel lymph node biopsy (SLNB) procedure. The CP-GEP model was developed by the Mayo Clinic and SkylineDx BV, and it has been clinically validated in multiple studies.

References

  1. 1 2 American Academy of Dermatology (February 2013), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation , American Academy of Dermatology , retrieved 5 December 2013, which cites