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Forum Name: Lymphoma

Question: likelihood of a false negative biopsy


 estellee - Tue Mar 24, 2009 12:51 pm

I August I discovered a swollen lymph node in neck during first trimester of pregnancy. Doc initially sent me for bloods and ultrasound just to measure it. She tested me for everything from mono to strep and ticks and found nothing wrong.
I subsequently miscarried and she sent me for a CT scan and Xray in September she also put me on antibiotics for 14 days just in case.
The Cat scan showed multiple swollen nodes in neck but chest was clear so she sent me to an endocrine surgeon who performed a FNA and full removal of lymph node. It came back negative for lymphoma, but I developed another swollen node in same area of neck. I was sent to an oncologist at a cancer center, he sent my lymph node for a second opinion and who had a PET scan done. By now it was already December and I still had a few swollen nodes in the area of my neck. The PET scan showed lymphadenopathy.


Now , in March I have about two small nodes swollen one the size of a pea and one the size of kidney bean. The doctor is still concerned about the PET scan and claims that even though the biopsy was negative he still wants me watched for at least six months before I consider myself free and clear.

My question, what besides lymphoma can be the cause of my swellings?
Is it possible to have a false negative biopsy when an entire node was removed in October?
 Dr. Tamer Fouad - Sat Mar 28, 2009 11:58 am

User avatar Hi,

It all depends on the clinical situation. Obviously the Gold Standard for diagnosis of any cancer is a biopsy. FNA are not very accurate for the diagnosis of lymphoma. However, if the lymphadenopathy has not been explained and a PET scan is positive. I would certainly think its prudent to stay under close follow up.

PETs are extremely sensitive meaning you won't get that many false negatives with those. Unfortunately, though they aren't very specific - ie, you can get false positives! Especially, distinguishing cancer from an inflammation is a common problem with most functional scans as they depend on increased cellular activity to locate the problem. Standardized uptake values (SUV) can help to distinguish between those.

I hope that helps.

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