Technical methods for lymphoreticular biopsies

Abstract

From a surgical point of view the diagnostic lymph node biopsy may be regarded as a minor operation. The repercussions of this biopsy, particularly in a young patient, may, however, be of far greater consequence than the heroics of the major operations’ list. Ideally the enlarged node to be biopsied should be identified, avoiding the upper cervical and inguinal nodes if possible, although this is not of great importance if there are definite pathological changes in the node. Once identified, the node should be excised with its capsule intact and without undue traction. When lymph node biopsies are relegated to the end of the list to be performed often by inexperienced surgeons, two mistakes are commonly made. The first of these is the removal of the most accessible node irrespective of its size. Such nodes frequently show only nonspecific reactive changes despite the presence of specific infection or neoplasm in deeper nodes. This mistake can frequently be recognized by the discrepancy between the size of the nodes described in the clinical summary on the request form and the size of the specimen received. In such circumstances the pathologist should ask for a repeat biopsy. The second common mistake arising from the timidity of inexperienced surgeons is to avulse the lymph node piecemeal through an inadequate skin incision. Unless the diagnosis is clear cut in such a specimen the pathologist should request a further biopsy.