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Lymph node biopsies in a general internal medicine department: algorithm or individualized decision-making?
F H Verbrugge1, M Stas, D Knockaert
1Department of General Internal Medicine, University Hospital Gasthuisberg, Leuven, België. frederik.verbrugge@student.kuleuven.be
Insights
Diagnosing lymphadenopathy (LA) in internal medicine is challenging. Malignancy exclusion is key, but individual assessment and multidisciplinary input are crucial for accurate diagnosis and avoiding sampling errors.
Area of Science:
- Internal Medicine
- Oncology
- Pathology
Background:
- Lymphadenopathy (LA) presents a significant diagnostic challenge in internal medicine.
- The primary concern in evaluating LA is the exclusion of malignancy.
Purpose of the Study:
- To identify variables correlated with malignancy in patients undergoing lymph node biopsy (LNB).
- To evaluate the diagnostic accuracy of histopathological analysis for malignancy in LA.
Main Methods:
- Retrospective case series of 40 adult patients undergoing LNB.
- Analysis of demographics, clinical data, and histopathological diagnoses.
- Minimum one-year follow-up for final diagnosis confirmation.
Main Results:
- Malignancy prevalence was 58%; older age correlated with malignancy.
- Painful lymphadenopathy was associated with a benign outcome.
- Histopathology correctly predicted malignancy in 93% of cases, with some initial benign diagnoses revised to lymphoma.
Conclusions:
- Individualized decision-making for LNB is recommended over universal algorithms.
- Multidisciplinary cooperation and careful consideration of all data are essential.
- Awareness of sampling errors and prolonged clinical follow-up are necessary to minimize false-negative diagnoses.
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.
Conclusion:
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.
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