As the surgical team in a Infectology Institute, every day we perform some lymph node biopsies, and, despite the criteria we use, still there are several pathological findings of reactive lymphadenomegaly. How do you choose the patient who will benefit from the biopsy and the right node to extract? Is there any room for FNA?
thanks to enquire,
nodes, liver and spleen provide doors to etiology of infectious diseases. every node is suspicious till proved etiology. reactive node itself teels us odd factor is there to which it reacts nad it is for us to decern its etiology. FNA is always initial tool to decipher the myth but needs biopsy to clear the fine lines. i believe it is the treating consultant who has to take onus of responsibility in assesing the need to go for biopsy or not.in addition there are centuries old rules for taking out nodes like hot nodes/ cervical v/s inguinal,clincal history, exposure to pets,drugs.....etc
Thank you for answering
HIV-positive patients are more susceptible to acquiring infectious (opportunistic) diseases, as well as to developing specific types do neoplasia. Some of these maladies can be diagnoses by node biopsy, and this procedure is in some cases the gold standard for the diagnose.
But, as suggested by Bogoch et al in the link attached, nearly half of the biopsies are inconclusive, and our experience is not so different from theirs (tuberculosis is more common than neoplasia in our Institute).It means to me that in 50-53% of these patients we could have avoided an invasive procedure, prone to (usually simple to treat) complications and scars.
We are looking for ways to reduce this percentage.
When do you call the Surgeon to perform a node biopsy in HIV-positive patients? Is any adenomegaly in these patients initially biopsied or some sorologies are made first? Which ones? What influence do the CD4 cells have on the choice?
Once again, thanks for the answer.
http://www.ncbi.nlm.nih.gov/m/pubmed/22805116/
Lymph node biopsy can be a diagnostic procedure in HIV+ patients with constitutional symptoms (fever, lost of weight) and a reasonable previous inconclusive workup - including radiology and serology. In my center (northern Portugal) reactive lymphadenomegaly is the top finding, followed by tuberculosis and lymphoma. CD4 counting does not influence biopsy indication, although correlates with histology findings.