Brittany Ryan's Video Answer of the Week: Biopsies

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Brittany Ryan was wrapping up her senior year in college and about ready to do what hundreds of thousands of people her age do every fall: begin the next, post-educational stage of her life by looking for a job and getting her future underway.

Cancer had other ideas.

That summer, Brittany was diagnosed with stage 4-B Hodgkin's lymphoma.

As her friends began new and exciting chapters in their lives, she began chemotherapy.

But that isn't all she did. She also launched a campaign, Live.Laugh.Lymphoma, to bring awareness to blood disorders and to help raise money for the Lymphoma Research Foundation.

Just recently, her doctors told her the good news: she was in remission. Knowing full well that that wasn't the end of it, Brittany has begun publishing weekly videos in which she answers questions about her treatment, her disease, her campaign, and many other things that people in this community want to know.

The Lymphoma Information Network will be featuring her weekly answer videos, and along the way finding out more about Brittany's experiences as a Hodgkin's patient.

This week, she discusses the biopsy.

Note: Current standard treatment guidelines from the National Comprehensive Cancer Network recommend an excisional biopsy for Hodgkin's lymphoma. However, they add that a core needle biopsy, which is what Brittany describes, can be considered adequate if it is determined to be diagnostic by a qualified hematopathologist.

Excluding bone marrow biopsy, there are three types of biopsies to consider.

The first is called fine-needle aspiration biopsy (FNAB). Here, a health care professional puts a small needle into a suspect lymph node and draws out some of its cells. This biopsy is not diagnostic by itself—in other words, an accurate diagnosis can't be achieved using just this type of biopsy.

The next is not really much more invasive. It is called core needle biopsy (CNB). As Brittany discusses, this too requires the insertion of a needle into a suspect lymph node, and a core sample of tissue is removed. This might be repeated more than once.

The last biopsy type is very invasive. An excisional biopsy is a surgical procedure where surgeons go in and remove an entire lymph node.

As you can see, with each biopsy the tissue sample gets larger. Reaching a diagnosis and determining other factors about Hodgkin's is easier with an excisional biopsy, as pathologists want to see the so-called architecture of the tissue and how the cancer cells fit into it.

However, while it has not yet reached the treatment guidelines, it appears as though the standard excisional biopsy- and the subsequent complications that can be associated with any surgical procedure- is being replaced by core needle biopsy followed by the likes of fluorescence in situ hybridization (FISH) and T-cell receptor (TCR) and immunoglobulin heavy chain (IGH) gene rearrangement studies. It is believed that the less invasive biopsy, when combined with these highly specific lab tests, can achieve the same diagnostic accuracy as an excisional biopsy but do it at a lower price for the patient and with fewer potential complications.

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