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Bayhan Z, Ozdemir K, Gonullu E, Harmantepe AT, Capoglu R, Akin E, Aziret M, Altintoprak F. ANALYSIS OF DIAGNOSTIC EXCISIONAL LYMPH NODE BIOPSY RESULTS: 12-YEAR EXPERIENCE OF A SINGLE CENTER. Acta Clin Croat 2023; 62:58-64. [PMID: 38304357 PMCID: PMC10829962 DOI: 10.20471/acc.2023.62.01.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 10/07/2021] [Indexed: 02/03/2024] Open
Abstract
Lymph node biopsy is indicated in patients with suspected malignancy or lymphadenopathy due to unclarified reasons. Lymph node biopsy can be performed as fine needle aspiration biopsy, core biopsy, or excisional lymph node biopsy. In particular, the diagnosis of malignant lymphoma is considered insufficient for oncological treatment unless classified into subgroups. Core biopsy and excisional biopsy can be performed to diagnose lymphoma and classify it into subgroups. Core biopsy may also be limited in some cases for the diagnosis of lymphoma. Therefore, patients are referred to surgical departments for excisional lymph node biopsy. It was aimed herein to analyze the results of excisional lymph node biopsies performed for diagnostic purposes in our department. Data on 73 patients having undergone diagnostic excisional lymph node biopsy at Sakarya University Medical Faculty Training and Research Hospital between January 2008 and January 2020 were retrospectively analyzed. Patients were evaluated in terms of age, gender, biopsy site, pathological diagnosis, number and diameter of lymph nodes excised. Patients younger than 18 years of age, those with sentinel lymph node biopsies, and lymph node dissections performed for any known malignancy were excluded from the study. Statistical data analysis was done using SPSS statistical software. There were 37 (50.7%) female and 36 (49.3%) male patients, mean age 52.07 (18-90) years. Axillary lymph node biopsy was performed in 32 patients, inguinal lymph node biopsy in 29 patients, cervical lymph node biopsy in 3 patients, intra-abdominal lymph node biopsy in 6 patients, mediastinal lymph node biopsy in 1 patient, and supraclavicular lymph node biopsy in 2 patients. All of the lymph node biopsies were performed as excisional biopsy. Malignancy was detected in 36 (49.3%) patients. In 37 (50.3%) patients, the causes of lymphadenopathy were found to be benign pathologies. When the causes of malignant disease were examined, it was observed that 23 (31.5%) patients were diagnosed with lymphoma. Hodgkin lymphoma was detected in 5 patients diagnosed with lymphoma, and non-Hodgkin lymphoma was found in 18 patients. Metastatic lymphadenopathy was observed in 13 (17.8%) patients. Reactive lymphoid hyperplasia (26%) and lymphadenitis (20.5%) were found among the causes of benign lymphadenopathy. The number of excised lymph nodes was between 1 and 4, and their diameter was between 9 and 75 mm (mean: 29.53±15.56 mm). There was no statistically significant difference between benign and malignant patients according to gender, age, lymph node diameter, number of lymph nodes excised, and excisional lymph node biopsy site. For diagnostic lymph node biopsy, fine-needle aspiration biopsy and core biopsy should be performed primarily. If lymphoma is suspected in the diagnosis, fine-needle aspiration biopsy is not necessary. In this case, it is believed that it is more appropriate to perform core biopsy first. If the core biopsy is insufficient for diagnosis, it is more appropriate to perform surgical biopsy in order to cause no delay in diagnosis and treatment. Excisional biopsy is a method that can be safely performed and does not cause severe morbidity in palpable peripheral lymphadenopathies. Although it does not cause severe morbidity because it is an invasive procedure, excisional biopsy should be performed in a selected patient group.
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Affiliation(s)
- Zulfu Bayhan
- Sakarya University Faculty of Medicine, Department of General Surgery, Sakarya, Turkey
| | - Kayhan Ozdemir
- Sakarya Research and Educational Hospital, Department of General Surgery, Sakarya, Turkey
| | - Emre Gonullu
- Sakarya Research and Educational Hospital, Department of Gastrointestinal Surgery, Sakarya, Turkey
| | - Ahmet Tarik Harmantepe
- Sakarya Research and Educational Hospital, Department of General Surgery, Sakarya, Turkey
| | - Recayi Capoglu
- Sakarya Research and Educational Hospital, Department of General Surgery, Sakarya, Turkey
| | - Emrah Akin
- Sakarya Research and Educational Hospital, Department of General Surgery, Sakarya, Turkey
| | - Mehmet Aziret
- Sakarya Research and Educational Hospital, Department of Gastrointestinal Surgery, Sakarya, Turkey
| | - Fatih Altintoprak
- Sakarya University Faculty of Medicine, Department of General Surgery, Sakarya, Turkey
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Yenilmez E, Verdi Y, Ilbak A, Demirkiran BC, Duman Z, Bozkurt F, Seyman D, Asan A, Eker HBS, Ceylan MR, Emre S, Altunyurt GO, Ayan S, Parlak E, Toros GY, Yoruk G, Ceylan M, Karaagac L, Ozguler M, Meral B, Ay M, Ozturk C, Karacaer Z, Tural E, Cetinkaya RA, Dokmetas I, Kose S. Demographic, clinical and laboratory characteristics for differential diagnosis of peripheral lymphadenopathy (LAP) and the etiologic distribution of LAP in adults; a multicenter, nested case-control study including 1401 patients from Turkey. Intern Emerg Med 2021; 16:2139-2153. [PMID: 33728579 DOI: 10.1007/s11739-021-02683-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 02/19/2021] [Indexed: 10/21/2022]
Abstract
Peripheral lymphadenopathy (LAP) is an important and common abnormal finding of the physical exam in general medical practice. We aimed to reveal the LAP etiology and demographic, clinical and laboratory variables that may be useful in the differential evaluation of LAP. This multicenter, nested case-control study including 1401 patients between 2014 and 2019 was conducted in 19 tertiary teaching and research hospitals from different regions in Turkey. The ratio of infectious, malign and autoimmune/inflammatory diseases was 31.3%, 5% and 0.3%, respectively. In 870 (62%) of patients had nonspecific etiology. Extrapulmonary tuberculosis (n: 235, 16.8%) was the most frequent cause of LAP. The ratio of infective etiology of LAP was significantly lower in patients older than 65 years-old compared to younger patients with the rate of 66.67% and 83.84%, respectively (p 0.016, OR 0.386, 95% Cl 0.186-0.803). The probability of malign etiology was higher both in patients who are older than 45 years-old (p < 0.001, OR 3.23, 95% Cl 1.99-5.26) and older than 65 years-old (p 0.002, OR 3.36, 95% Cl 1.69-6.68). Age, localization and duration of LAP, leukocytosis, anemia, thrombocytopenia, CRP and sedimentation rate were important parameters to differentiate infections. Size of lymph node and splenomegaly in addition to the parameters above were useful parameters for differentiating malign from benign etiology. Despite the improvements in diagnostic tools, reaching a definite differential diagnosis of lymphadenopathy is still challenging. Our results may help clinicians to decide in which cases they need an aggressive workup and set strategies on optimizing the diagnostic approach of adulthood lymphadenopathy.
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Affiliation(s)
- Ercan Yenilmez
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Sultan Abdulhamid Han Training and Research Hospital, 34668, Uskudar, Istanbul, Turkey.
| | - Yıldız Verdi
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Ayca Ilbak
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Sultan Abdulhamid Han Training and Research Hospital, 34668, Uskudar, Istanbul, Turkey
| | - Burcu Caliskan Demirkiran
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Zehra Duman
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Fatma Bozkurt
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Derya Seyman
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Ali Asan
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Halime Betul Sahin Eker
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Adana City Hospital, Adana, Turkey
| | - Mehmet Resat Ceylan
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Harran University, Sanliurfa, Turkey
| | - Salih Emre
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Prof. Dr. Cemil Tascıoglu City Hospital, Istanbul, Turkey
| | - Gozde Ozturk Altunyurt
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Kartal Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Saliha Ayan
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Emine Parlak
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ataturk University, Erzurum, Turkey
| | - Goknur Yapar Toros
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Dr. Abdurrahman Yurtaslan Ankara Onkoloji Training and Research Hospital, Ankara, Turkey
| | - Gulsen Yoruk
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, İstanbul Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Ceylan
- Department of Infectious Diseases and Clinical Microbiology, Bakircay University, Cigli Training and Research Hospital, Izmir, Turkey
| | - Leman Karaagac
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Mehmet Akif Inan Training and Research Hospital, Sanliurfa, Turkey
| | - Muge Ozguler
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Fethi Sekin City Hospital, Elazığ, Turkey
| | - Busra Meral
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Muzeyyen Ay
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Cinar Ozturk
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Zehra Karacaer
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Ersin Tural
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Sultan Abdulhamid Han Training and Research Hospital, 34668, Uskudar, Istanbul, Turkey
| | - Rıza Aytac Cetinkaya
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Sultan Abdulhamid Han Training and Research Hospital, 34668, Uskudar, Istanbul, Turkey
| | - Ilyas Dokmetas
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Sukran Kose
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
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