From the Guidelines
Interpreting lymph node biopsy results requires a comprehensive approach, including hematopathology review, immunophenotyping, and possibly molecular testing, to establish an accurate diagnosis and guide treatment decisions. When interpreting lymph node biopsy results, it is essential to consider the findings in the context of the patient's medical history and other test results. The pathology report will typically classify the results as either benign (non-cancerous) or malignant (cancerous), with benign findings indicating infection, inflammation, or reactive changes, and malignant results showing lymphoma, metastatic cancer, or other cancerous conditions 1.
Key Considerations
- An incisional or excisional lymph node biopsy is recommended to establish the diagnosis of non-Hodgkin's lymphoma (NHL), as it provides a more comprehensive tissue sample for analysis 1.
- Fine needle aspiration (FNA) biopsy alone is not generally suitable for the initial diagnosis of lymphoma, but it may be used in combination with core biopsy and ancillary techniques, such as immunohistochemistry and flow cytometry, in certain circumstances 1.
- Immunophenotypic analysis is essential for differentiating the various subtypes of NHL and can be performed using flow cytometry and/or immunohistochemistry 1.
Diagnostic Approach
The diagnostic approach typically involves:
- Morphologic assessment to determine cell size and morphology
- Clinical features, including patient age and location of the lymph node
- Initial immunophenotyping panel, including Pan-B and Pan-T-cell antigens
- Possibly, additional immunophenotyping and molecular testing to establish a specific diagnosis 1
Treatment Implications
The interpretation of lymph node biopsy results has significant implications for treatment decisions, as the type, grade, and stage of cancer detected will guide the selection of appropriate treatment options. It is crucial to consult with a healthcare provider to understand the specific findings and implications of the biopsy results. The healthcare provider will consider the biopsy results alongside other test results and medical history to determine the best course of treatment, which may include chemotherapy, radiation therapy, or other interventions 1.
From the Research
Interpreting Lymph Node Biopsy Results
To interpret lymph node biopsy results, it is essential to understand the principles of diagnostic histopathology. The diagnosis and differential diagnosis of lymphomas, as well as their distinction from benign conditions, are among the most frequent and most difficult problems in diagnostic histopathology 2.
Key Considerations
- Meticulous attention to detail is essential at all phases in the preparation of a satisfactory lymph node biopsy 2.
- The testing modalities available and necessary to precisely diagnose lymphadenopathies, lymphadenitides, and lymphomas are numerous, and the triage of each individual lymph node sample with judicious apportionment of tissue for diagnostic testing has become of paramount importance 3.
- Recent advances in the immunological characterization of human lymphocyte sub-populations, and the use of selected cytochemistry techniques have enabled increased understanding of the pathogenesis of malignant lymphomas, as well as providing more precise categorization of the cell of origin of many of these tumours 2.
Sentinel Lymph Node Biopsy
Sentinel lymph node biopsy has become a standard staging tool in the surgical management of breast cancer, with a positive impact on postoperative negative outcomes in breast cancer patients, without compromising the oncological outcomes 4.
- The sentinel lymph node (SLN) is the first node to receive the drainage directly from a tumor, and detection and pathological examination of the SLN is an important oncological procedure that minimizes morbidity related to extensive nodal dissection 5.
- SLN biopsy has become the standard surgical treatment in patients with malignant melanoma, breast, vulvar, and cervical cancers, with the introduction of new technologies, such as fluorescent dyes and near-infrared fluorescence, increasing the SLN detection rate and decreasing the false-negative rate 5.
Therapeutic Implications
The therapeutic landscape for lymphomas is diverse and includes active surveillance, chemotherapy, immunotherapy, radiation therapy, and stem cell transplant, with advances in the field leading to the development of targeted therapies 6.
- Targeted therapies, such as rituximab and brentuximab vedotin, have shown strong efficacy in treating lymphoproliferative disorders, but the complex biology of the tumors has allowed for the malignant cells to develop various mechanisms of resistance to the targeted therapies 6.