Lymph Node Biopsy
Pediatric Lymph Node Biopsy
Overview
Lymph node biopsy in pediatric patients is a crucial diagnostic procedure for evaluating persistent lymphadenopathy and diagnosing various conditions including malignancies, infections, and autoimmune disorders. The procedure involves surgical removal of all or part of a lymph node for detailed pathological examination.
Key Points
- Essential diagnostic tool for unexplained lymphadenopathy
- Critical for lymphoma diagnosis and staging
- Multiple approaches based on location and clinical suspicion
- Requires careful specimen handling
- Time-sensitive processing for optimal results
Biopsy Approaches
- Fine Needle Aspiration (FNA)
- Least invasive option
- Good for initial screening
- Limited sample size
- May need image guidance
- Core Needle Biopsy
- Larger tissue sample than FNA
- Better architectural preservation
- Can be ultrasound-guided
- Good for deep lymph nodes
- Excisional Biopsy
- Complete node removal
- Gold standard for lymphoma diagnosis
- Provides maximum tissue for analysis
- Better diagnostic accuracy
- Incisional Biopsy
- Partial node removal
- Used for very large nodes
- When complete excision is risky
Primary Indications
- Suspected Malignancy
- Persistent lymphadenopathy
- Rapid nodal enlargement
- Constitutional symptoms
- Suspicious imaging findings
- Infectious Causes
- Tuberculosis
- Atypical mycobacterial infection
- Persistent viral lymphadenitis
- Fungal infections
- Other Conditions
- Autoimmune disorders
- Storage diseases
- Histiocytic disorders
- Unexplained systemic disease
Clinical Features Warranting Biopsy
- Size >2cm without obvious cause
- Progression despite antibiotics
- Supraclavicular location
- Hard, fixed, or matted nodes
- Associated systemic symptoms
Absolute Contraindications
- Severe bleeding disorders
- Active local infection
- Unstable cardiopulmonary status
- Inability to obtain consent
Relative Contraindications
- Proximity to vital structures
- Previous radiation to biopsy site
- Significant scarring
- Moderate coagulopathy
Pre-procedure Evaluation
- Laboratory Studies
- Complete blood count
- Coagulation profile
- Basic metabolic panel
- Relevant infectious markers
- Imaging Studies
- Ultrasound mapping
- CT/MRI if indicated
- PET scan in selected cases
Excisional Biopsy Steps
- Proper positioning and preparation
- Anatomical marking and planning
- Local anesthesia or general anesthesia
- Careful dissection through tissue planes
- Node identification and isolation
- Meticulous hemostasis
- Complete node removal when possible
- Proper specimen handling
- Layer-by-layer closure
Specimen Handling
- Immediate pathology notification
- Fresh tissue processing
- Multiple study preparations
- Flow cytometry
- Frozen section
- Culture studies
- Molecular studies
Pathological Analysis
- Gross Examination
- Size and consistency
- Cut surface appearance
- Presence of necrosis
- Microscopic Examination
- Architecture assessment
- Cellular patterns
- Special staining requirements
- Special Studies
- Immunohistochemistry
- Molecular testing
- Cytogenetics
- PCR studies
Early Complications
- Bleeding
- Local hematoma
- Active hemorrhage
- Nerve injury
- Infection
- Wound dehiscence
- Seroma formation
Late Complications
- Scarring
- Chronic pain
- Lymphatic dysfunction
- Keloid formation
Immediate Post-Procedure Care
- Wound Care
- Dressing management
- Infection prevention
- Activity restrictions
- Monitoring
- Bleeding signs
- Pain control
- Neurological status
Follow-up Care
- Wound assessment schedule
- Results discussion timing
- Activity resumption guidelines
- Warning signs review
Long-term Management
- Pathology review
- Treatment planning
- Surveillance requirements
- Additional testing needs
