Different Types of Diagnostic Biopsies
- A lymph node biopsy removes an entire node or part of one for testing
- A bone marrow biopsy looks for evidence that cancer has spread from the nodes to the marrow
- A lumbar puncture can help determine whether the fluid around the brain or spine is affected
Before ordering the biopsy, your doctor will do some other tests first, and if those tests point to a suspicion of non-Hodgkin lymphoma, a biopsy can give a definitive diagnosis. First the doctor will do a physical exam to check for swelling and tenderness. And you may have a blood test to see if your red or white blood cell count is low. You may also have a CT or PET scan.Read More
Lymph Node BiopsyThe two main types of biopsies performed to diagnose non-Hodgkin lymphoma include needle biopsies and surgical biopsies. A surgical biopsy, in which doctors remove the entire lymph node for testing, is generally the preferred method. "If it's an easily accessible lymph node, one that's right under the skin, then it can be done simply with an injection of some local anesthesia, some numbing medication, and then a small incision to remove the lymph node," explains Dr. Piro.
If the lymph node is located in an area that's more difficult to access, it can be a slightly more elaborate procedure. "Sometimes it's more complicated," says Dr. Piro. "For example, if the lymph node to be biopsied is in the armpits, there's a lot of nerves there, and the doctor has to be very careful not to nick a nerve." In this case the biopsy is a more intensive kind of operation, and it may even require that the patient be asleep during the procedure.
Needle biopsies, in which only a small portion of the lymph node is removed, are done when surgical biopsies would be difficult or impossible. Needle biopsies, for example, may be used if the swollen lymph node is too close to important nerves or blood vessels, or too deep within the body to reach easily.
Almost all lymph node biopsies, whether surgical biopsies or needle biopsies, can be done as outpatient procedures, and the patient will be sent home when the biopsy is completed.
Bone Marrow Biopsy
If the lymph node biopsy finds evidence of cancer, another type of biopsy is often recommended to see how far the cancer has spread. "There's usually a staging process, which consists of doing a bone marrow biopsy," says Dr. Piro.
In this type of biopsy, a needle is used to remove liquid and tissue bone and marrow from the pelvis. The tissue is sent to a pathoglogy lab to be checked under the microscope for evidence of non-Hodgkin lymphoma. Cancer that has spread from the lymph nodes to the bone marrow is considered advanced.
Finally, a third type of procedure, not technically a biopsy, is also used to remove substances from the body for testing. A lumbar puncture is done when the doctor suspects a type of NHL that may spread to the fluid that surrounds the spine and brain. Like a needle biopsy, this test involves inserting a needle into the back in this case, into the spinal canal to remove a sample of fluid for examination. The test is usually done under local anesthesia.
Which biopsies any patient winds up getting depends on the symptoms they present with and the evidence the doctor finds of what might be happening inside their body. Together these biopsies along with imaging procedures like PET and CT scans can give your doctor a good picture of your disease and how best to treat it.
Reviewed by Dr. Adrienne Phillips, hematologist/oncologist, Weill Cornell Medicine