Lymph node biopsy
When a node needs tissue, choosing excision, core biopsy, FNA or EBUS, which node to take, how to send it (fresh for flow and genetics, culture for TB), reading the pathology report, and the traps: steroids before biopsy, FNA for lymphoma, and the non-diagnostic reactive result.
Tier 2Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Most enlarged nodes are reactive and settle in weeks. Biopsy the node that is large, hard, supraclavicular, persistent or growing, or comes with B symptoms, cytopenias or a high LDH.
- Excision biopsy is the reference standard for lymphoma (Lugano 2014). Image-guided core biopsy is an accepted alternative when excision is hard or slow. FNA is for carcinoma, infection and recurrence, not a first lymphoma diagnosis.
- Send part of the node fresh, not in formalin, for flow cytometry and genetics.
Loading the rest of the note…
Finished reading?
Sources
- Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classificationCheson BD et al., J Clin Oncol 2014;32:3059-68, 2014
- Diagnostic performance and safety of ultrasound-guided core needle biopsy for diagnosing lymphoma: a systematic review and meta-analysisKwon Y, Lee MK. Cancer Med 2025;14:e70414, 2025
- Systematic review of the effectiveness of fine-needle aspiration and/or core needle biopsy for subclassifying lymphomaFrederiksen JK et al., Arch Pathol Lab Med 2015;139:245-51, 2015
- The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: Lymphoid NeoplasmsAlaggio R et al., Leukemia 2022;36:1720-48, 2022
- RCPA Manual (lymph node biopsy, flow cytometry)AU/NZRoyal College of Pathologists of Australasia
- Optimal care pathway for people with Hodgkin and non-Hodgkin lymphomaAU/NZCancer Council Australia
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Deploy to Cloudflare on push to main