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Document Details : Title: Lymph node biopsies in a general internal medicine department: algorithm or individualized decision-making? Author(s): VERBRUGGE FH, STAS M, KNOCKAERT D, TOUSSEYN T, VANDERSCHUEREN S Journal: Acta Clinica Belgica Volume: 66 Issue: 4 Date: 2011 Pages: 274-279 DOI: 10.2143/ACB.66.4.1002973 Abstract : Background: Lymphadenopathy (LA) imposes a diagnostic challenge in internal medicine. Exclusion of malignancy is the primary concern. Methods: A retrospective case series, including 40 adult patients from the general internal medicine department who underwent lymph node biopsy (LNB) at a single university hospital. Demographics, clinical data and histopathological diagnoses were registered. By means of the latest medical record, we obtained a fi nal diagnosis for each patient and subsequently searched for variables correlated with malignancy. Follow-up was at least one year in 95% of cases. Results: The prevalence of malignancy was 58%. Older age (p = 0.02) was signifi cantly correlated with malignancy. The presence of painful lymphadenopathy at clinical examination (p = 0.02) was signifi cantly associated with a benign outcome. No single or combination of baseline variables satisfactorily excluded malignancy. Histopathological analysis correctly predicted malignancy in 93% of cases. In two cases, an initial diagnosis of benign non-specifi c lymphadenopathy was reversed to non-Hodgkin lymphoma. In one case the pathological diagnosis was inconclusive. Conclusion: Rather than following a universal algorithm to determine the need for LNB in patients with LA, we call for individualized decision-making in each case, carefully appreciating all available information. Additionally, one should keep in mind that false-negative results occur due to sampling errors. Therefore, a minimal number of cases should end with a final diagnosis of benign non-specific lymphadenopathy. Intensive, multidisciplinary cooperation with surgeon and pathologist is needed. Moreover, clinical follow-up should be at least one year. |
