Percutaneous lymph node biopsy

Sonographically guided core-needle biopsy in the diagnosis of superficial lymphadenopathy

PURPOSE

This study was designed to evaluate the efficacy of ultrasound-guided percutaneous core-needle biopsy for establishing histopathologic diagnoses of palpable enlarged lymph nodes.

METHODS

Thirty patients without a history of malignancy or recent infection underwent ultrasound-guided core-needle lymph node biopsies. Only patients with enlarged lymph nodes ranging from 1.5 to 3.5 cm in greatest diameter that had been present for more than 2 months were included in this study. Two cores from each lymph node were obtained by a freehand core-needle biopsy technique using a 7-MHz ultrasound transducer and an automatic spring-loaded biopsy gun with an 18-gauge cutting needle.

RESULTS

The histologic diagnoses were conclusive in 24 cases (80%) and inconclusive in 6 cases (20%). In the 24 conclusive cases, the lymph node enlargement was due to benign causes in 12 cases and malignancy in 12 cases. All specimens in the conclusive cases were sufficient for histologic diagnosis, but there was insufficient material for a diagnosis in 3 of the inconclusive cases. No complications were seen in this series.

CONCLUSIONS

Ultrasound-guided core-needle biopsy of enlarged lymph nodes is a safe, minimally invasive alternative to surgical biopsy, enabling a histologic diagnosis for treatment planning in most cases.

Diagnostic value of lymph node fine needle aspiration cytology: an institutional experience of 387 cases observed over a 5-year period

Lymph node fine needle aspiration (LNFNA) cytology is valuable in solving the diagnostic problems of clinical adenopathy. The usefulness of the procedure in the staging and diagnosis of various malignant and lymphoproliferative tumours, as well as its role in distinguishing reactive hyperplastic lymph nodes from lymphoma, has been documented in the literature generally on an individual basis. We report our cumulative 5 year experience of LNFNA representing 387 cases. Approximately half (n = 182) were diagnosed as either metastatic carcinoma or melanoma; in 54 cases (30%) excisional biopsy or tissue study was performed to confirm the diagnosis; there was only one false-positive diagnosis of a metastatic squamous carcinoma rendered on a submandibular lymph node. Sixty-one lymphoma cases were successfully diagnosed via LNFNA with no false positives; concurrent flow cytometry was utilized in 51% (n = 31) of the 61 cases and supported the cytologic diagnosis of lymphoma in 27 of the 31 cases (87%). A benign or reactive lymph node process was also diagnosed via LNFNA alone or in combination with flow cytometry in 48 cases with only five false negatives, which included four cases of mantle cell lymphoma and one case of melanoma. Unsatisfactory cases accounted for 12%, and represented specimens obtained by 'Wang needle' or other emerging techniques. Our study demonstrates that LNFNA can be an accurate, economical and rapid diagnostic procedure.