title: Lymph node biopsies in a general internal medicine department: algorithm or individualized decision-making?
abstract: BACKGROUND
  Lymphadenopathy (LA) imposes a diagnostic challenge in internal medicine. Exclusion of malignancy is the primary concern.
  
  
  METHODS
  A retrospective case series, including 40 adult patients from the general internal medicine department who underwent lymph node biopsy (LNB) at a single university hospital. Demographics, clinical data and histopathological diagnoses were registered. By means of the latest medical record, we obtained a final diagnosis for each patient and subsequently searched for variables correlated with malignancy. Follow-up was at least one year in 95% of cases.
  
  
  RESULTS
  The prevalence of malignancy was 58%. Older age (p = 0.02) was significantly correlated with malignancy. The presence of painful lymphadenopathy at clinical examination (p = 0.02) was significantly associated with a benign outcome. No single or combination of baseline variables satisfactorily excluded malignancy. Histopathological analysis correctly predicted malignancy in 93% of cases. In two cases, an initial diagnosis of benign non-specific lymphadenopathy was reversed to non-Hodgkin lymphoma. In one case the pathological diagnosis was inconclusive.
  
  
  CONCLUSIONS
  Rather than following a universal algorithm to determine the need for LNB in patients with LA, we call for individualized decision-making in each case, carefully appreciating all available information. Additionally, one should keep in mind that false-negative results occur due to sampling errors. Therefore, a minimal number of cases should end with a final diagnosis of benign non-specific lymphadenopathy. Intensive, multidisciplinary cooperation with surgeon and pathologist is needed. Moreover, clinical follow-up should be at least one year.
authors.affiliation: Department of General Internal Medicine, University Hospital Gasthuisberg, Leuven, België. frederik.verbrugge@student.kuleuven.be
authors.forename: F H
authors.initials: FH
authors.lastname: Verbrugge
authors.forename: M
authors.initials: M
authors.lastname: Stas
authors.forename: D
authors.initials: D
authors.lastname: Knockaert
authors.forename: T
authors.initials: T
authors.lastname: Tousseyn
authors.forename: S
authors.initials: S
authors.lastname: Vanderschueren
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001707:Biopsy, Needle / Q000706:statistics & numerical data*; D003657:Decision Making; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008206:Lymphatic Diseases / Q000175:diagnosis* / Q000209:etiology; D008207:Lymphatic Metastasis; D008223:Lymphoma / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000473:pathology*; D012189:Retrospective Studies; D055815:Young Adult