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Lymph node biopsy - Large Biopsy 3-6 cm

Biopsy
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Biopsy of lymph node tissue.

₹666₹951

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Lymph Node Biopsy - Large Biopsy 3-6 cm

  • Why is it done?
    • Test Purpose: A large lymph node biopsy (3-6 cm) involves the surgical removal and microscopic examination of an enlarged lymph node to obtain tissue samples for diagnostic analysis, allowing pathologists to identify abnormal cells, infections, or malignancies.
    • Primary Indications: Suspected lymphoma or other hematologic malignancies; persistent unexplained lymphadenopathy; evaluation of enlarged nodes unresponsive to treatment; suspected metastatic cancer; evaluation of granulomatous diseases; suspected tuberculosis or atypical mycobacterial infections; evaluation of persistent infections; assessment of immunodeficiency-related lymphadenopathy.
    • Typical Timing: Performed when lymph nodes remain enlarged (3-6 cm or larger) for more than 2-4 weeks; when imaging studies show suspicious features; when fine needle aspiration is inconclusive or non-diagnostic; when clinical suspicion for malignancy is high; as part of staging for known malignancies.
    • Specimen Size: Large biopsy format (3-6 cm) provides sufficient tissue for comprehensive histopathologic analysis, flow cytometry, immunophenotyping, cytogenetics, molecular studies, and microbiologic cultures when indicated.
  • Normal Range
    • Normal/Benign Findings: Reactive hyperplasia with normal lymphoid follicles; preserved lymph node architecture; normal germinal centers; appropriate T and B cell distribution on immunostaining; absence of abnormal cells; no evidence of malignancy; negative cultures for pathogens.
    • Normal Histopathologic Features: Small lymphocytes predominate; intact capsule and trabeculae; patent sinuses; appropriate number and size of germinal centers; background macrophages; no atypical mitotic figures.
    • Result Interpretation: NEGATIVE or BENIGN = No evidence of malignancy, specific infection, or granulomatous disease; findings consistent with reactive lymphadenopathy.
    • Units of Measurement: Pathologic diagnosis (categorical); node size in centimeters; immunophenotypic percentages (%); cytogenetic findings (abnormalities present/absent); molecular markers (positive/negative).
    • Clinical Correlation: Normal/benign results do not exclude malignancy if clinical suspicion remains high; may indicate reactive changes due to recent infection or inflammatory conditions; recommend follow-up imaging or repeat biopsy if clinical presentation warrants further investigation.
  • Interpretation
    • Positive for Malignancy: Presence of lymphoma (Hodgkin or non-Hodgkin types); metastatic carcinoma from primary site; leukemic involvement; thymoma; sarcoma; melanoma; other primary malignancies. Results typically specify histologic type, grade, stage, and immunophenotype for prognostication and treatment planning.
    • Granulomatous Inflammation: Suggests tuberculosis, histoplasmosis, coccidioidomycosis, sarcoidosis, berylliosis, or other granulomatous diseases; requires additional testing (cultures, stains, clinical correlation) to determine etiology.
    • Infectious Organisms Identified: Bacteria (Bartonella, Mycobacterium), fungi (Cryptococcus, Histoplasma), viral inclusions, parasites; may include organisms cultured from tissue samples; requires antimicrobial sensitivities and appropriate treatment selection.
    • Reactive Hyperplasia: Normal response to infection or inflammation; preserved lymph node architecture; increased germinal centers; appropriate cellular responses; indicates benign etiology but does not exclude underlying systemic disease.
    • Factors Affecting Interpretation: Adequacy of tissue sampling; prior chemotherapy or radiation affecting cellularity; immunosuppression status; anatomic location of lymph node; timing of biopsy relative to clinical presentation; presence of overlapping histopathologic features; quality of tissue fixation and processing.
    • Complementary Findings: Flow cytometry results; immunohistochemistry panel results; cytogenetic abnormalities (t(14;18), t(9;22), etc.); molecular findings (gene rearrangements, mutations); culture results with organism identification and sensitivities.
    • Clinical Significance: Results guide definitive diagnosis, prognostication, treatment selection, and monitoring strategy; benign findings may allow reassurance but require clinical correlation; malignant findings necessitate staging studies and oncologic consultation; infectious findings guide antimicrobial or specific therapy.
  • Associated Organs
    • Primary Organ System: Lymphatic system; immune system; reticuloendothelial system.
    • Lymph Node Sites Commonly Biopsied: Cervical (neck) nodes; mediastinal (chest) nodes; axillary (armpit) nodes; inguinal (groin) nodes; retroperitoneal (abdominal) nodes; supraclavicular nodes.
    • Lymphomas Diagnosed: Hodgkin lymphoma; diffuse large B-cell lymphoma (DLBCL); follicular lymphoma; small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL); mantle cell lymphoma; Burkitt lymphoma; peripheral T-cell lymphomas; primary mediastinal B-cell lymphoma; nodal marginal zone lymphoma.
    • Metastatic Diseases Detected: Carcinoma (breast, lung, gastric, colorectal, renal, ovarian, endometrial, thyroid); sarcoma; melanoma; germ cell tumors; head and neck malignancies; nasopharyngeal carcinoma.
    • Infectious Diseases Identified: Tuberculosis; atypical mycobacterial infections; histoplasmosis; coccidioidomycosis; cryptococcosis; toxoplasmosis; cat scratch disease (Bartonella); cytomegalovirus; Epstein-Barr virus; HIV-associated lymphadenopathy; syphilis.
    • Granulomatous Diseases: Sarcoidosis; tuberculosis; fungal infections; berylliosis; hypersensitivity pneumonitis; inflammatory bowel disease; chronic granulomatous disease.
    • Complications and Risks: Bleeding or hematoma formation; infection at biopsy site; nerve injury (facial, hypoglossal, or recurrent laryngeal nerve depending on location); vascular injury; cosmetic deformity; rare cases of severe hemorrhage requiring transfusion; pneumothorax if thoracic node biopsy; incomplete diagnosis requiring repeat sampling.
    • Secondary Organ Involvement: Liver, spleen, bone marrow, lungs, central nervous system, and other organs may be involved in lymphoid malignancies; systemic staging required for treatment planning; lymphadenopathy may reflect primary disease in these organs.
  • Follow-up Tests
    • Staging Studies for Malignancy: CT chest/abdomen/pelvis; PET-CT scan; bone marrow biopsy; CSF examination if CNS involvement suspected; additional imaging based on histology.
    • Laboratory Studies Post-Biopsy: Complete blood count (CBC); comprehensive metabolic panel; lactate dehydrogenase (LDH); uric acid; international normalized ratio (INR) and prothrombin time (PT) if bleeding complications occur.
    • Additional Pathologic Studies: Immunohistochemistry if not completed on initial biopsy; flow cytometry for lymphoid phenotyping; fluorescence in situ hybridization (FISH) for specific translocations; cytogenetics for chromosomal abnormalities; molecular studies (PCR for clonality, specific mutations); gene expression profiling for prognostication.
    • Microbiologic Studies: Bacterial, fungal, and mycobacterial cultures; acid-fast stain (AFB) for tuberculosis; special stains (Gram, Giemsa, GMS); serology if infectious disease suspected; chest X-ray for pulmonary involvement.
    • If Malignancy Confirmed: Oncology consultation; treatment planning studies (imaging, staging); prognostic factor testing (ki-67, gene mutations, specific markers); minimal residual disease testing if applicable; baseline imaging for treatment response monitoring.
    • If Benign/Reactive: Follow-up imaging in 4-6 weeks to confirm resolution; repeat biopsy if lymphadenopathy persists and clinical suspicion remains high; evaluation for systemic causes (infection workup, autoimmune serologies, thyroid function tests).
    • If Infectious Etiology Identified: Infectious disease consultation; organism-specific additional testing; antimicrobial sensitivities; repeat cultures if indicated; response to therapy assessment; imaging to evaluate for disseminated disease.
    • Monitoring Frequency: For malignancy: Clinical evaluation and imaging per protocol (typically every 8-12 weeks initially); for infectious diseases: Follow-up at 2-4 weeks after starting treatment; clinical and radiologic reassessment based on diagnosis and treatment response.
    • Related/Complementary Tests: Fine needle aspiration (FNA) biopsy; core needle biopsy; excisional biopsy; imaging (ultrasound, CT, MRI, PET); blood tests; bone marrow examination; other tissue biopsies if indicated.
  • Fasting Required?
    • Fasting Requirement: NO - Fasting is not required for lymph node biopsy. This is a surgical procedure that typically requires general or local anesthesia with sedation, and fasting requirements depend on the anesthesia type used.
    • If Sedation/Anesthesia Required: NPO (nothing by mouth) typically for 6-8 hours before procedure if general anesthesia planned; may be shorter for local anesthesia only; clear liquids may be allowed up to 2-3 hours before procedure depending on anesthesia type; confirm specific fasting requirements with your surgical center.
    • Medications to Avoid: Anticoagulants (warfarin, NOACs) - typically held 3-5 days before biopsy; antiplatelet agents (aspirin, clopidogrel) - typically held 5-7 days before biopsy; NSAIDs - typically held 3-5 days before biopsy; herbal supplements (ginkgo, ginseng, St. John's Wort) - hold 1-2 weeks before; confirm with surgeon which medications to discontinue.
    • Coagulation Assessment: Prothrombin time (PT/INR) and activated partial thromboplastin time (aPTT) may be ordered pre-operatively; platelet count checked; history of bleeding disorders must be disclosed; fresh frozen plasma or platelet transfusion may be required if coagulopathy present.
    • Other Patient Preparation: Arrange for someone to drive you home (if sedation used); wear comfortable, loose-fitting clothing; remove jewelry and piercings; bladder emptying before procedure; full informed consent discussion; report current medications, supplements, and allergies; avoid smoking 24 hours before if possible.
    • Pre-Procedure Imaging: Ultrasound or CT imaging to localize the lymph node; marking of biopsy site; identification of anatomic landmarks; assessment of needle approach.
    • Post-Procedure Instructions: Keep biopsy site clean and dry; resume normal diet once alert if sedation used; apply ice pack for 24 hours to reduce swelling; take over-the-counter analgesics for pain as needed; avoid strenuous activity for 24-48 hours; report signs of infection (fever, drainage), excessive bleeding, or increasing swelling; follow-up appointment in 1-2 weeks to remove sutures if needed.

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