Lymph Node Biopsy?

RE: Lymph Node Biopsy?

Rach — Thu, 01 Dec 2016 08:34:52 GMT

I wonder if it would be worth running a PARR on the FNA slides before considering surgical biopsy? My understanding is, provided the dog has no history of travel (Leishmaniasis and some other imported infectious diseases can create what appears to be a clonal response in the lymph node) then a clonal response on PARR would strongly support lymphoma.

RE: Lymph Node Biopsy?

Bob Russell — Wed, 30 Nov 2016 14:24:51 GMT

I don't trust FNA's from submandibular LN's. Almost always 'reactive'. Many dogs have enlarged submandibular Ln's without "serious" pathology. Usually manky teeth so get those sorted!!

Tend to remove a popliteal for biopsy. Really easy to get to and generally diagnostic.

RE: Lymph Node Biopsy?

Lou Dawson — Tue, 29 Nov 2016 21:18:50 GMT

Pathologist here. Whole node far better for diagnosis, and allows assessment of architecture of the whole node which biopsy samples don't. Mostly we can say lymphoma or not lymphoma on punches/wedges but if you want the lymphoma classified then we need to see architecture. In addition, lymph nodes are quite soft and incisional biopsies cause a lot of artefacts in the tissues which can decrease the diagnostic quality of the sample. As for not providing FNA results...some lymphomas (e.g. T-zone lymphoma) are really difficult to differentiate from hyperplasia on histo and the whole clinical picture is so important for reaching the diagnosis. Even then we still sometimes need additional tests (IHC, PARR). There is no need for you to 'test' your pathologist by withholding information especially when it can affect the outcome for your patient.

RE: Lymph Node Biopsy?

grumpyoldman — Thu, 12 May 2016 17:34:46 GMT

Probably best to take the swollen node , if its labrador have a look in its eyes for Aqueous flare, apparently 70% have abnormal cells , Aqueo-centesis is quick and easy and may give you an answer without cutting anything. I thought node architecture was important to the pathologist ,as well as cell morphology.

RE: Lymph Node Biopsy?

Roland Bulkyn-Rackowe — Thu, 12 May 2016 10:35:16 GMT

I'll often biopsy the popliteal node. A few tests I have run / may be useful: biochemistry, haematology with a smear, PARR, CLBT.

http://www.tddslab.co.uk/system/resources/kcfinder/upload/files/Canine%20Clonality%20(PARR)%20Information(1).pdf

http://lymphoma.avactaanimalhealth.com/

I must be a sucker for reps.

RE: Lymph Node Biopsy?

Tim Charlesworth — Mon, 09 May 2016 17:56:59 GMT

[quote user="skatealexia"]

As a new grad I have my first suspected case of lymphoma in a labrador. FNA came back as 'highly suggestive' so discussed with the owner to go down the biopsy route to be more sure. The submandibular LN are bilaterally palpably enlarged and this was where my FNA came from. My notes say to use the popliteal LN for excisional biopsy and to avoid the submandibular- the popliteal isn't palpably enlarged on either side though. What do people tend to do in this instance?

[/quote]

We would normally remove the popliteal or prescap LN if all the LN's were enlarged as the submandib LN's tend to be reactive as has been said previously. If, however, the submandib LN's are the only LN's to be enlarged then I would biopsy these. If the cytology is almost there but not quite, then you would expect a histo section to not have any probs confirming the diagnosis. I would always remove the LN in its entirety, there are many other regional LN's which will pick up the slack and resecting the SMLN is straight forward enough. If it is massive then you could biopsy it instead but if you're making a surgical approach then I would make the most of it. Best of luck,

Tim

RE: Lymph Node Biopsy?

Anthony Dennison — Mon, 09 May 2016 17:38:17 GMT

[quote user="David Mills"] I often send these without noting the FNA findings to the pathologist so as not to unconsciously sway the outcome (this might get brickbats).[/quote]

What a fantastic idea. Sure the pathologists won't think so though!

RE: Lymph Node Biopsy?

Robin Grimmer — Mon, 09 May 2016 12:58:59 GMT

[quote user="Neil Wheadon"]

[quote user="Robin Grimmer"]I normally excise the whole node[/quote]

I'm genuinely curious why you would take the whole node? My view is that it's there for a purpose so would be curious how things would work afterwards. It's a simple plumbing argument as the popliteal drains the leg or am I being too simplistic?

Neil

[/quote]

The lymph node itself doesn't drain the leg, the lymphatics do. Otherwise you'd get massive oedema afterwards. ;)

Maybe the pathologist would prefer the whole node? Having said this I usually do fna first.

RE: Lymph Node Biopsy?

Neil Wheadon — Mon, 09 May 2016 12:36:26 GMT

[quote user="Robin Grimmer"]I normally excise the whole node[/quote]

Neil

RE: Lymph Node Biopsy?

David Mills — Mon, 09 May 2016 09:38:55 GMT

Decent punch biopsy would be my approach. Make sure you go deep enough, may need to peel away the surrounding fat first. I wouldn't take the whole SMLN out - fiddly and not required. Can do under decent d/t sedation and a bit of local in about 5 minutes, one skin suture.

Contrary to other posters (well, one), if the external cytology came back as suggestive of lymphoma I'd be very surprised if the histo didn't as well. I often send these without noting the FNA findings to the pathologist so as not to unconsciously sway the outcome (this might get brickbats).

RE: Lymph Node Biopsy?

Robin Grimmer — Mon, 09 May 2016 09:21:49 GMT

[quote user="skatealexia"]

Pu/pd and lethargy from the clinical signs

[/quote]

Is the dog hypercalcaemic? When I do a biopsy on a popliteal node, I normally excise the whole node. However with a sub mandibular node that can be rather fiddly so you can take an incisional biopsy which is easier.

RE: Lymph Node Biopsy?

skatealexia — Mon, 09 May 2016 08:03:14 GMT

Pu/pd and lethargy from the clinical signs

RE: Lymph Node Biopsy?

Martin Atkinson — Sun, 08 May 2016 23:02:23 GMT

I would question the diagnosis if the only enlarged nodes are submandibular. The reason they are a poor choice is because they are so reactive to any oral inflammatory process. Any other reasons to suspect lymphoma?

RE: Lymph Node Biopsy?

niall morton — Sun, 08 May 2016 22:33:19 GMT

I usually go popliteal but in my early days (not that long ago) I always went submandibular and removed the whole gland, they always came back diagnostic but with a histology note to say that SM glands not always the best. I would do what ever you feel most comfortable with surgically, from the sounds of the FNA you'll get your diagnosis what ever you do

RE: Lymph Node Biopsy?

skatealexia — Sun, 08 May 2016 21:48:29 GMT

I tried the prescaps the other day, and no enlargement palpable at that time! I'll repalpate tomorrow in case I can feel any others enlarged as I'd rather not biopsy the submand unless I really have to.

RE: Lymph Node Biopsy?

Noweia — Sun, 08 May 2016 21:46:09 GMT

Can you feel any other nodes? I find the prescapular LNs useful here, but of course not if they're not enlarged!