How Your Doctor Uses Biopsies to Make Your Diagnosis of Non-Hodgkin Lymphoma

A biopsy is a test to check for lymphoma. For it, your doctor removes a small piece of tissue or fluid from the place that may have lymphoma. Then, the tissue is checked by a pathologist, a type of specialist who looks at the tissue under a microscope for lymphoma cells. A biopsy is the only way to diagnose non-Hodgkin lymphoma.

Here are the kinds of biopsies that may be done to confirm a diagnosis of lymphoma. These are done in either a doctor's office or hospital. Where you have it done depends on what part of your body the tissue is being taken from. It usually takes several days for the results of your biopsy to come back from the pathologist:

  • Excisional or incisional biopsy. With an excisional biopsy, a surgeon takes out a whole lymph node. With an incisional biopsy, the surgeon takes out only part of the lymph node or tumor. How you are numbed for the procedure depends on where the node or tumor is. For lymph nodes just under the skin, you may have a local anesthetic. The local numbs the skin around the node. For lymph nodes or tumors deeper in the body, you may have a general anesthesia. A general puts you to sleep so that you don't feel anything. This biopsy almost always gives the pathologist enough tissue to make a full diagnosis. This is the preferred procedure for the diagnosis of lymphoma.

  • Fine needle aspiration (FNA) biopsy. A doctor inserts a very thin, hollow needle attached to a syringe to take a small sample of tissue from a tumor. If the tumor is deep inside your body, the surgeon may guide the needle with the help of ultrasound or computed tomography (CT). A CT scanner is a kind of X-ray imaging machine that lets your doctor see inside your body. Although this procedure avoids surgery, it does not always remove enough tissue for the pathologist to look at, which may not allow for a definite diagnosis. It is helpful, however, in ruling out other problems. For instance, it can identify infection in nodes.

  • Bone marrow aspiration and biopsy. This test is often done after lymphoma has been diagnosed. Before making a small cut in the skin over the hip bone, the doctor numbs the area with a local anesthetic, usually given as an injection. Then the doctor inserts a needle to take out a small amount of liquid marrow from the back of your hip bone. You may need to have this done on both hips. Next, the doctor takes out a solid piece of bone and marrow. Even with anesthesia, you may feel discomfort for a few minutes as the doctor removes the marrow and bone. This biopsy may confirm a diagnosis of lymphoma, but is more often done to see what stage the lymphoma is, by determining whether the lymphoma has reached the bone marrow.