How to Perform Pathological Diagnosis of Axillary Lymphoma

When diagnosing axillary lymphoma, obtaining a complete lymph node through surgical excision is generally the preferred method. While fine-needle aspiration (FNA) can be effective in certain classic cases, it often falls short when dealing with complex or atypical presentations that require comprehensive diagnostic criteria and multiple reference indicators.

Why a Complete Lymph Node Biopsy Is Crucial

A full lymph node specimen provides essential structural context, including the capsule and surrounding cellular background, which are vital for accurate classification. This architectural integrity allows pathologists to assess patterns of cell distribution, identify abnormal infiltrates, and differentiate between reactive changes and malignant transformation—especially important in subtypes like follicular lymphoma or Hodgkin's disease.

Limits of Needle Aspiration and Partial Sampling

Fine-needle aspiration often retrieves only fragmented cells without tissue architecture, increasing the risk of sampling error. In some instances, the needle may miss the most representative or affected area of the lymph node, leading to false-negative results or inconclusive findings. Similarly, incisional biopsy—removing just a portion of the node—may fail to capture malignant regions if they are focal or heterogeneous within the tissue.

The Advantage of Excisional Biopsy in Axillary Nodes

Excisional biopsy—complete removal of an enlarged lymph node from the axilla—is minimally invasive and technically straightforward due to the accessibility of the region. It offers a high diagnostic yield by preserving the entire nodal structure. This approach significantly improves diagnostic accuracy, enabling not only confirmation of lymphoma but also subclassification into specific types such as diffuse large B-cell lymphoma or peripheral T-cell lymphoma, which directly impacts treatment planning.

Moreover, having a whole lymph node allows for advanced testing, including immunohistochemistry, flow cytometry, molecular studies, and genetic profiling—all critical tools in modern hematopathology. These tests rely on sufficient tissue volume and intact cellular relationships, which are best preserved in fully excised specimens.

In summary, while less invasive methods may seem convenient, excisional biopsy remains the gold standard for diagnosing axillary lymphoma. It maximizes the chances of reaching a definitive diagnosis, reduces the need for repeat procedures, and supports precision medicine approaches in oncology care.