The use of fine needle aspiration biopsy in patients with multiple lymphadenopathy before open biopsy

When a clinician is faced with a patient who presents with lymphadenopathy and in whom the clinical examination and routine investigations are normal, excision biopsy is usually the next step of management to obtain a tissue diagnosis. In a patient who has multiple lymphadenopathy, deciding on which node to biopsy can be difficult because some of the enlarged nodes may not reflect the true disease process. When such a lymph node is biopsied, the actual diagnosis can be delayed or even missed. Fine needle aspiration biopsy has been shown to be an effective tool in the investigation of multiple lymphadenopathy. Many, if not all, of the enlarged lymph nodes can be sampled at one sitting. If this procedure fails to provide a definitive diagnosis, the clinician should then proceed on to an open biopsy. Two cases of multiple lymphadenopathy in which open biopsies failed to reveal the true nature of the disease but subsequent fine needle aspiration biopsies did are presented and discussed.