Excisional lymph node biopsy
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Excisional lymph node biopsy is a surgical diagnostic procedure in which a suspicious lymph node is completely removed for further examination. The analysis may include histological, and if necessary, immunohistochemical, microbiological, or molecular studies. The procedure is used for accurate diagnosis of lymphomas, metastases, specific infections, or other lymphoproliferative disorders. In cases of suspected lymphoma, excisional biopsy is the preferred method because it allows a complete assessment of the node’s structure.
Indications
- Persistent or progressive lymphadenopathy without a clear diagnosis
- Suspected lymphoma (clinically or based on imaging results)
- Suspected lymph node metastases
- Lymphadenopathy with “alarm” symptoms: unexplained weight loss, fever, night sweats
- Inconclusive result from fine-needle aspiration or core biopsy
- Suspected specific or granulomatous infections, including lymph node tuberculosis, requiring confirmation
Procedure
- Performed under aseptic conditions, most often under local anesthesia for superficial nodes; general anesthesia or sedation may be used if necessary
- The surgeon makes a small incision, identifies the suspicious node, and completely removes it, controlling bleeding and protecting surrounding structures
- The excised node is sent to the pathology laboratory; additional studies may be performed if needed, including immunohistochemistry, flow cytometry, or microbiological cultures
- The procedure allows a complete morphological analysis of the node, enabling accurate diagnosis and guiding treatment strategy
Sources:
https://www.ummhealth.org/health-library/excisional-biopsy-neck-lymph-node
https://pmc.ncbi.nlm.nih.gov/articles/PMC10829962/
https://dam.esmo.org/image/upload/v1671554148/For%20patients/Patient%20Guides/Follicular%20Lymphoma/EN-Follicular-Lymphoma-Guide-for-Patients.pdf?utm
https://www.researchgate.net/publication/336978354_Excisional_Lymph_Node_Biopsy
https://mft.nhs.uk/app/uploads/2020/08/Lymph-Node-Biopsy.pdf?utm
https://www.iroiasi.ro/userfiles/files/ghiduri/ghid-5/continut-ghid-5-2022-indicatii-doze-si-fractionare-delimitarea-volumelor-tinta-in-radioterapie-ghid-practic.pdf?utm
https://www.ecdc.europa.eu/sites/default/files/documents/handbook-diagnostic-methods-tb.pdf?utm
Preparation:
- Consultation with a surgeon and/or oncologist
- Standard laboratory tests, including complete blood count and coagulation profile
- Review of current medications, especially anticoagulants and antiplatelet drugs
- Identification of the target node through physical examination and/or ultrasound
- Follow recommendations regarding diet and hydration if general anesthesia or sedation is planned
- If necessary, discontinue medications affecting blood coagulation as instructed by the physician
- Ensure optimal conditions for the procedure (rest, skin preparation, absence of infection in the operative area)
