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    Lymph node core biopsy

    Background

    Lymph node core biopsies are commonly used in the investigation of lymphadenopathy for suspected lymphoma, tumours of unknown origin and inflammatory/infective processes.1-3

    See separate protocols for lymph node excisions, sentinel and regional lymph node specimens from breast tumours and melanoma.


    Record the patient identifying information and any clinical information supplied together with the specimen description as designated on the container. See overview page for more detail on identification principles.

    • No
      • Non-routine fixation (not formalin), describe.
    • Yes
      • Special studies required, describe.
      • Ensure samples are taken prior to fixation.2

    Fresh unfixed tissue should be handled in appropriate extraction cabinets and with suitable personal protection equipment for infection control. Where sufficient material is available, unfixed specimens may be sampled for special studies using a fresh, sterile blade and distributed to appropriate laboratories (internal and external). These may include frozen section, imprints, flow cytometry, cytogenetics, molecular studies, microbiology, tissue bank and electron microscopy.2

    In some instances only a small amount of tissue may be submitted. In such cases specimen triage is critical and discussion with the reporting Pathologist is advisable to optimise the diagnostic yield of the tissue available.

    See general information for more detail on specimen handling procedures.


    External Inspection

    Describe the following features of the specimen:

    Procedure

    Record as described by the clinician.

    Specimen type

    Record as described by the clinician.

    Specimen integrity

    • Number of cores
    • If fragmented, number of pieces received

    Specimen size (mm)

    • In two dimensions, length and diameter

    Dissection

    Not required.


    Internal Inspection

    Not required.


    Processing

    • If fresh tissue is received, clarification of any special tests required should be sought from the requesting clinician, if not stated on the request form.
    • If received fresh or in saline, the solution should be replaced with fresh formalin. Indeed, even if stated that it is received in formalin, replenishment with fresh formalin from the laboratory is advisable. Saline is often used during the surgical procedure to dislodge tissue biopsies into a specimen pot containing formalin thus diluting its concentration and impairing fixation.
    • Consideration should be given to submitting each core (in its entirety) in a separate cassette to enable sufficient material for ancillary studies. Ensure appropriate lining in cassettes to prevent loss of tissue during processing.

    Record details of each cassette.

    An illustrated block key similar to the one provided may be useful.

    Block allocation key

    Cassette id
    Site
    No. of pieces
    A
    Lymph node core biopsy
     
     

    Acknowledgements

    Associate Professors David Ellis and John Miliauskas for their contribution in reviewing and editing this protocol.


    References

    1. Australian Cancer Network Diagnosis and Management of Lymphoma Guidelines Working Party. Guidelines for the Diagnosis and Management of Lymphoma. The Cancer Council Australia and Australian Cancer Network, Sydney, 2005.
    2. Norris D, Ellis D, Green M, Joske D, Macardle P, Miliauskas J, Spagnolo D and Turner J. Tumours of haematopoietic and lymphoid tissue structured reporting protocol, The Royal College of Pathologists of Australasia, Surry Hills, NSW, 2010.
    3. Ramsay A, Attygale A, Menon G, Naresh K and Wilkins B. Tissue pathways for lymph node, spleen and bone marrow trephine biopsy specimens, The Royal College of Pathologists, London, 2008.

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    Copyright © 2019 RCPA. All rights reserved.

    26-Mar-2019
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