Diagnosing Lymphoma With a Biopsy
- A biopsy is the only way to confirm that you have lymphoma, and find out which type you have
- A surgical biopsy can provide your doctor with a large enough tissue sample to diagnose you
- Needle biopsies are less invasive, but they may not be able to confirm the diagnosis
“If you haven’t had a biopsy, then we cannot give you a diagnosis of lymphoma,” Dr. Elise Chong, medical oncologist at Penn Medicine, tells SurvivorNet. “We really need to see tissue under the microscope to make that diagnosis.”
Read MoreSurgical Biopsy
In a surgical biopsy, the surgeon has to cut through the skin to remove a tissue sample, usually from a lymph node. In an excisional biopsy the doctor removes the whole lymph node. In an incisional biopsy the doctor removes only part of the lymph node or tumor.Having surgery to diagnose your cancer might sound frightening, but it’s critical for your doctor to have a large enough sample to provide the necessary information about your cancer. Your doctor needs to know what type of lymphoma you have in order to treat it correctly.
“Because there’s so many different types of lymphoma, it’s really important that we have an adequate tissue sample so that the pathologist can really look under the microscope and see what the architecture looks like, how the cells are arranged, what specific types of cells there are, to really give a firm diagnosis on the type of lymphoma,” Dr. Chong says.
You’ll get medicine before the surgery to prevent you from feeling pain. If the node is deep inside your body, you may be asleep during the procedure. The doctor will make a small cut through your skin, remove the suspected lymph node or piece of a lymph node, and then close the opening with stitches. You may be able to go home on the same day.
Needle Biopsy
The alternative to a surgical biopsy is a needle biopsy. As the name suggests, it uses a needle to remove a tissue sample. You’ll likely get a local anesthetic beforehand to numb the area of skin.
A needle biopsy can be done in one of two ways:
- A fine needle aspirate uses a very thin, hollow needle, which goes into your skin right above the lymph node. Then the doctor uses an attached syringe to pull out (aspirate) a small sample of tissue.
- A core needle biopsy uses a thicker needle to remove a slightly larger tissue sample. Your doctor might use an ultrasound or computed tomography (CT) scan to find the lymph node, especially if it is deeper inside your body.
“The difference is that a core needle biopsy is a very thin hollow needle where we’re taking a much smaller sample of a lymph node or other organ that may have lymphoma in it, versus the needle is sucking out individual cells,” Dr. Chong says.
After the Biopsy
Once your biopsy is finished, your doctor will send your sample to a lab. There, a specialist called a pathologist will examine the cells under the microscope to see if you have lymphoma, and if so, which type you have.
Though a needle biopsy is less invasive than a surgical one, there is always a risk that your doctor won’t be able to remove enough of a sample to get an accurate diagnosis. “Because architecture and the appearance of the cells and their arrangement under the microscope really matters, if you have a fine needle aspirate biopsy or a smaller core biopsy, this may not give you the degree of information to tell you about the type of lymphoma you have,” Dr. Chong says.
So even if you can get away with a less invasive needle biopsy, you may have to undergo a surgical biopsy later for your doctor to give you a firm diagnosis. Before you go in for this test, make sure you understand what questions it can answer, and whether you might need further tests afterward.
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