Lymph Node Biopsy

 Definition

Lymph node biopsy is the surgical excision of an active lymph node or needle aspiration of a nodal specimen for histological examination. Both techniques usually use local anesthesia and sample superficial nodes in the cervical, supraclavicular, axillary, or inguinal region. Excision, the preferred technique, provides a larger specimen.

Microscopic examination of the tissue specimen distinguishes malignant from non malignant causes of lymph node enlargement. Hodgkin’s disease, a lymphoma affecting the entire lymph system, is the leading cancer in adolescents and young adults. Lymph node malignancy may also result from metastatic cancer.

Purpose

• To determine the cause of lymph node enlargement.
• To distinguish between benign and malignant lymph node processes.
• To stage metastatic cancer.

Procedure

Preparation

1. Make sure the patient has signed an appropriate consent form.
2. Note and report all allergies.
3. Check the patient’s history for hypersensitivity to anesthetic.
4. For excisional biopsy, instruct the patient to restrict food from midnight and to drink clear liquids only.
5. If the patient will receive a general anesthetic, tell him to restrict fluids.
6. For a needle biopsy, no restriction of fluid or foods is necessary.
7. Explain that the test takes 15 to 30 minutes.

Implementation

Excisional Biopsy

1. Prepare the skin over the biopsy site, and drape the area for privacy.
2. The doctor administers the anesthetic.
3. Makes an incision, removes the entire node, and places it in a properly labeled bottle containing normal saline solution.
4. After the biopsy, he sutures the wound and applies a sterile dressing.

Needle Biopsy

1. The doctor prepares the site and administers a local anesthetic.
2. Grasps the node between thumb and forefinger, inserts the needle directly into the node, and obtains a small core specimen.
3. Removes the needle and places the specimen in a properly labeled bottle containing normal saline solution.
4. Pressure is exerted on the biopsy site to control bleeding, and an adhesive bandage is applied.

Nursing Interventions

1. Tell the patient to resume his usual diet and activity.
2. Monitor vital signs.
3. Watch for bleeding and infection
4. Observe the biopsy site.

Interpretation

Normal Results

1. Lymph node encapsulated by collagenous connective tissue and divided into smaller lobes by tissue strands (trabeculae).
2. Outer cortex composed of lymphoid cells and nodules or follicles containing lymphocytes.
3. Inner medulla composed of reticular phagocytic cells that collect and drain fluid.

Abnormal Results

1. Lymphatic cancer
2. Hodgkin’s disease

Interfering Factors

• Inability to obtain representative tissue specimen.
• Inability to differentiate nodal disorder

Precautions

• Storing the tissue specimen in normal saline solution instead of 10% formalin solution allows part of the specimen to be used for cytologic impression smears, which are studied along with the biopsy specimen.

Complications

• Bleeding
• Infections