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
- Make sure the patient has signed an appropriate consent form.
- Note and report all allergies.
- Check the patient’s history for hypersensitivity to anesthetic.
- For excisional biopsy, instruct the patient to restrict food from midnight and to drink clear liquids only.
- If the patient will receive a general anesthetic, tell him to restrict fluids.
- For a needle biopsy, no restriction of fluid or foods is necessary.
- Explain that the test takes 15 to 30 minutes.
Implementation
Excisional Biopsy
- Prepare the skin over the biopsy site, and drape the area for privacy.
- The doctor administers the anesthetic.
- Makes an incision, removes the entire node, and places it in a properly labeled bottle containing normal saline solution.
- After the biopsy, he sutures the wound and applies a sterile dressing.
Needle Biopsy
- The doctor prepares the site and administers a local anesthetic.
- Grasps the node between thumb and forefinger, inserts the needle directly into the node, and obtains a small core specimen.
- Removes the needle and places the specimen in a properly labeled bottle containing normal saline solution.
- Pressure is exerted on the biopsy site to control bleeding, and an adhesive bandage is applied.
Nursing Interventions
- Tell the patient to resume his usual diet and activity.
- Monitor vital signs.
- Watch for bleeding and infection
- Observe the biopsy site.
Interpretation
Normal Results
- Lymph node encapsulated by collagenous connective tissue and divided into smaller lobes by tissue strands (trabeculae).
- Outer cortex composed of lymphoid cells and nodules or follicles containing lymphocytes.
- Inner medulla composed of reticular phagocytic cells that collect and drain fluid.
Abnormal Results
- Lymphatic cancer
- 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
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