Different Types of Biopsies
- A lymph node biopsy removes an entire node — or part of one — for testing
- A bone marrow biopsy looks for evidence that cancer has spread from the nodes to the marrow
- A lumbar puncture (not technically a biopsy) can help determine whether the brain or spine are affected
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.
Read MoreNeedle 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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