Why is an excisional biopsy recommended for lymphoma instead of a needle biopsy?

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MichaelGrossbardMD (Physician - Oncology - Hematology/Oncology (Verified) ) - 07 / 05 / 2012

The preference of most lymphoma specialists is to obtain an excisional biopsy rather than a core needle biopsy or fine needle aspirate when feasible in order to make an accurate diagnosis. An excisional biopsy not only allows the treating doctor to get information about the proteins present on the surface of the tumor cell, but also permits a thorough analysis of the morphology (how a lymphoma looks under a microscope). Since a fine needle aspirate provides only a small sample of a lymph node, it may not provide sufficient tissue for an accurate diagnosis of the lymphoma subtype. Some lymphomas also do not have consistent pathology throughout a lymph node which can represent a mixture of an aggressive and a nonaggressive lymphoma. Accurate sampling is critical in order to determine how aggressively and lymphoma needs to be treated.

There are settings in which it can be difficult to obtain an excisional biopsy without performing an open surgical procedure. In those situations, it is reasonable to consider whether enough diagnostic information can be obtained using a core needle biopsy or fine needle aspirate thereby allowing the patient to avoid a surgical procedure that may have some associated risk and may delay the institution of therapy.
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