Lymph node biopsy

Role

Lymph node biopsy (excisional preferred over needle biopsy when lymphoma is suspected) provides the architecture necessary for accurate lymphoma diagnosis and subtyping - a core investigation whenever lymphoma is a leading differential for lymphadenopathy
Central to the workup of persistent, unexplained, or high-risk-feature lymphadenopathy (see lymph nodes for the general approach to assessing lymphadenopathy)

Excisional biopsy provides intact nodal architecture, essential for distinguishing lymphoma subtypes (which are defined partly by architectural pattern - follicular vs diffuse growth pattern, for example) and for accurate WHO classification - fine needle aspiration alone is generally inadequate for a definitive lymphoma diagnosis, since it provides only cytology without architecture

Tissue is examined by histology, immunohistochemistry (to determine cell lineage and subtype-specific markers), flow cytometry (immunophenotyping), and, where relevant, cytogenetic/molecular studies (e.g. detecting characteristic translocations) - the combined picture, not histology alone, establishes the full modern lymphoma diagnosis
Core needle biopsy is an intermediate option, increasingly used and often adequate, but excisional biopsy remains preferred when core biopsy is non-diagnostic or when a larger, more representative sample is needed

Confirmed subtype and stage (from biopsy plus subsequent staging investigations) directly determines treatment approach, given the enormous variation in management and prognosis between different lymphoma subtypes

Hodgkin lymphoma, non-Hodgkin lymphoma (multiple subtypes), reactive lymphadenopathy (the key benign differential), metastatic carcinoma to lymph nodes

Choosing an inadequate initial biopsy technique (e.g. fine needle aspiration alone when lymphoma is genuinely suspected) risks a non-diagnostic result requiring a repeat, more invasive procedure - matching biopsy technique to the differential diagnosis from the outset avoids this delay

5 more sections, plus exam facts

Premium unlocks every note across every specialty, and the full exam fact library behind it.