All About Biopsies to Diagnose Non-Hodgkin Lymphoma

If your doctor suspects that non-Hodgkin lymphoma may be responsible for your symptoms, they will almost certainly order a biopsy to make a definitive diagnosis. Symptoms of non-Hodgkin lymphoma and other types of lymphoma often include noticeably swollen lymph nodes in the neck, under the arms, or in the groin area.

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. When your symptoms and these preliminary tests indicate that non-Hodgkin lymphoma may be present,  a lymph node biopsy is generally the next step.

“A lymph node biopsy is always part of the solution, and you want to biopsy the most accessible lymph node, or the one that’s most likely to give a good result,” explains Dr. Lawrence Piro, a hematologist/oncologist at The Angeles Clinic & Research Institute in Los Angeles. That’s why your doctor has first done a physical exam to see which lymph nodes are tender or swollen. The type of biopsy you receive, and where the procedure is done, depends on where the node to be biopsied is located.

Lymph Node Biopsy

The two main types of lymph node biopsies performed to diagnose non-Hodgkin lymphoma are 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.

Needle biopsies, in which only a small portion of the lymph node is removed, are done when surgical biopsies would be difficult or impossible, for instance, if the lymph node is located in an area that’s more difficult to access. “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,” explains Dr. Piro. In this case the surgical biopsy may be a more intensive kind of procedure, or the doctor may opt to do a needle biopsy instead.

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 pathology 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.

Lumbar Puncture

A third type of procedure is not technically a biopsy. A lumbar puncture is done when the doctor suspects a type of non-Hodgkin lymphoma 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.

The types of biopsies your doctor recommends will depend on the symptoms you present with and the evidence the doctor finds of what might be happening inside your 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.

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