Lymph Node Biopsy

Went running early this morning (45 minutes, about 30 minutes in it started pouring!), so that I could get it done before my appointment. At 8:45 I was scheduled for the needle biopsy of the enlarged lymph node in my armpit, and I wasn't sure about how I would feel afterward.

There was a mix-up with scheduling, and the interventional radiologist and pathologist were both over on the East Bank, and I was with the ultrasound tech on the West Bank. As I'd feared, the interventional radiologist told the tech that he wasn't really sure what to biopsy (see the Frustration post - Dr. Pollock at MD Anderson had wanted an enlarged lymph node biopsied, but the University of Minnesota did not really think there was anything to worry about - the nodes looked fine, and there's only been one case of MPNST spreading to the lymph nodes without spreading to distant organs as well. But I just want to be as conservative as possible.). I'd almost cancelled this appointment in order to have it done down in Houston, but it will take two weeks to receive the paperwork that I'll need to fill out for travel reimbursement, and I didn't want to wait another two weeks.

After a discussion with me and with my orthopedic surgeon, the interventional radiologist agreed to do the needle biopsy on the lymph node in question. My other concern was that the University of Minnesota wouldn't biopsy the lymph node that concerned Dr. Pollock, but turns out there were only two nodes visible in the MRI, so I feel a little more confident that it was.

A needle biopsy is done by inserting a tiny needle multiple times into the tissue, guided by ultrasound. Cells are picked up by capillary pressure in the needle. After a few lidocaine shots to numb up my armpit, the interventional radiologist used different angles to try to access the lymph node. After inserting the needle multiple times, he handed it off to the pathologist, who verified that the cells were actually from the lymph node. The first few were not, so we kept going (I guess this is normal - even if a pathologist is not present, they collect enough cells for multiple slides, and hope they got enough of the proper type of cell). Finally, the pathologist started seeing lymphocytes. The interventional radiologist collected a few more needles of cells, and my armpit was getting a bit sore by this point, as he was pushing he needle and ultrasound transducer pretty hard, and I needed a second round of lidocaine.

Finally, they decided they had collected enough cells, a few bandaids were applied, and I was sent home. I feel like I got kicked a few times in the armpit, but not that bad in relation to other things I've had done, and I'm told it should feel back to normal tomorrow. Hopefully I will hear the results by Friday or Monday.

Turns out the pathologist was familiar with my case - both the arm tumor and the liver mass. I guess both were fairly unusual, so they made their rounds within the department. Not really the way I wanted to become famous. The arm tumor had been sent to Mayo for diagnosis verification, which I knew, but I learned today that of the 20,000 or so tissue samples read at the University of Minnesota Pathology Department each year, only about 10 are sent to outside institutions for help with diagnosis.