Do I need to get FNB or biopsy to check lymph node enlargement?

Question

Hi doctor,

I am a 32-year-old male. My height is 6 feet and my weight is 145 lbs. I am facing a significant unexplained weight loss of more than 45 lbs in four months. My normal weight since high school is 185 to 180 lbs. I am having episodes of significant and frequent drenching night sweats. Also, I have chronic persistent fatigue and occasional non-specific itching. I have a family history of lymphoma with my paternal uncle and a maternal cousin. My ultrasound of lymph nodes has two different impressions. The first one was clear bilateral LAD suspicion of neoplastic etiology seen at levels 4 and 5. The second opinion was clearly reactive bilateral nodes seen at levels 2 and 5. In your opinion, what would be the appropriate course of action? Either FNB or excisional biopsy due to the symptoms and history? Also, if you can interpret films, then I would appreciate your additional opinion. From a differential diagnosis standpoint, what is at the top?

Answer 1

Hi,

Welcome to icliniq.com.

Based on your query and attached images (attachment removed to protect patient identity), my opinion is as follows:

In view of the clinical symptoms, images could be more of neoplastic etiology. Clearly, with the family history and prominent nodes along with the classical history of night sweats, further evaluation is definitely necessary.
FNB (fine needle biopsy) is usually an initial test and the final confirmation is by biopsy. FNB has its limitations, however, to avoid any surgery; FNB of two lymph nodes can be done. If suspicious or positive, then can go for a biopsy, which will require further studies for characterization.
FNB is usually my initial choice; however, a biopsy will be necessary for confirmation. However, evaluation of nodes is compulsory by looking at radiological findings, family history, and symptoms.
CBC (complete blood count), being normal indicates that there is no leukemia or lymphoma spillover into the peripheral blood. Lymph node evaluation is necessary.

Answer 2

Hi,

Welcome back to icliniq.com.

Yes, in relation to alcohol use, in a few patients with lymphoma, lymph nodes do become tender. However, the exact cause of it is not identified.
Mild elevation of alkaline phosphatase, LDH (lactate dehydrogenase) and albumin are not to be worried about.
Increased neutrophil, probably secondary to mild bacterial infection could be causing mild abnormal liver function test values.
Get the tests done. Hope, it is only reactive lymph nodes and not lymphoma. Do get back after tests for anything of concern.