ABSTRACT
How to handle needle core biopsies 167 Limitations, problems and pitfalls 168 Advantages of needle core biopsies 170
Endoscopic ultrasound biopsies 171 References 186
Since the publication of the previous editions of this book we have seen a further increase in the use of needle core biopsies of lymph nodes for diagnostic purposes. This has been made possible by the expansion and improvement of immunohistochemistry. Biopsies are often taken by radiologists using computed tomography (CT) guidance and are thus targeted at the node that appears most pathological rather than the most accessible one. CT-guided needle biopsies have been of particular value in the diagnosis of deepseated lesions, such as retroperitoneal tumours, that would previously have required laparoscopy or laparotomy. The biopsy can be relatively easily repeated should the first one be unsatisfactory or unrepresentative. If the diagnosis is of a lymphoma, the patient can begin chemotherapy immediately without having to await recovery from abdominal surgery. We are being further challenged by the increasing use of endoscopic ultrasound (EUS) to sample mediastinal and deep abdominal nodes using fine needle aspiration (FNA). Ancillary techniques such as flow cytometry and cell blocks of FNA material may allow a firm diagnosis in a reasonable proportion of these samples.
