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10.5005/jp-journals-10007-1100 WJOLS
REVIEW ARTICLE A Review of the Role of Laparoscopic Biopsy in Cases of Abdominal Lymphadenopathy
A Review of the Role of Laparoscopic Biopsy in

Cases of Abdominal Lymphadenopathy

Amitabh Thakur
Registrar, Department of General Surgery, KEM Hospital, Mumbai, Maharashtra, India

Abstract
Lymphadenopathy, identified incidentally during computed tomography, is a common clinical scenario faced by clinicians, and often
poses a diagnostic challenge mandating a tissue diagnosis. In the absence of palpable peripheral nodes, tissue has to be obtained from
the abdominal nodes by image guided biopsy or surgery. In this context, a laparoscopic biopsy avoids the morbidity of a laparotomy.
Keywords: Abdomen, Biopsy, Laparoscopy, Lymph node, Lymphoma, Tuberculosis.

INTRODUCTION (FNA) or core biopsy has developed into dependable and
minimally invasive alternatives for acquiring tissue.
The lymphatic system is an important component of the
immune system. It includes lymphatic fluid, lymphatic Oftentimes, however the tissue obtained is not sufficient
vessels, lymph nodes, spleen, tonsils, adenoids, Peyer’s for histological evaluation or the location of the adenopathy
3-6
patches, and the thymus. 1 is not amenable to a CT/ultrasound (US)-guided biopsy.
Lymph nodes are composed of follicles and contain an While laparotomy remains the gold standard for
abundance of lymphocytes. Lymph is filtered through the retroperitoneal lymph node biopsy, it is an invasive procedure
lymph node sinuses where particulates and infectious associated with prolonged hospital stay and subsequent
organisms are detected and removed. Because of the recovery time. The laparoscopic approach to adenopathy
exposure to immune challenges, antibody and cell immunity offers the potential benefit of decreased recovery time and
is mediated. As a result of such normal processes, the lymph postoperative morbidity compared with open techniques as
nodes can enlarge by proliferation of normal cells or well as increased likelihood of obtaining adequate tissue.
infiltration by abnormal cells. AIM
Lymphadenopathy is defined as the enlargement of one
or more lymph nodes as a result of normal reactive effects This is a retrospective analysis of laparoscopic biopsy of
or a pathologic occurrence. While size is the most common abdominal lymph nodes. The objective of this study is to
reference, others include an abnormal number or alteration assess the safety, efficacy, and diagnostic accuracy of
in consistency as a pathologic change that requires laparoscopic biopsy.
investigation. 1
Currently, computed tomography (CT) is increasingly MATERIALS AND METHODS
widely utilized for vague abdominal symptoms due to its It is a retrospective review of 87 cases from four different
high sensitivity. The result of this technological trend is an sources:
increased incidence of unexpected retroperitoneal and 1. From January 1999 to June 2001, 19 laparoscopic
mesenteric lymphadenopathy. The diagnosis of mediastinal biopsies were performed for 18 patients with intra- or
and intra-abdominal lymphadenopathy is sometimes difficult, retroperitoneal lymphadenopathy at Ospedale San
especially in patients without any other primary lesions and Martino di Genova, Genova. In 15 patients, the biopsy
without any specific serological findings. This may be was performed in order to achieve the diagnosis. In the
caused by primary lymphoproliferative disorders, metastasis, other four cases, laparoscopic biopsy was required to
2
sarcoidosis, tuberculosis and so on. Until recently, enlarged confirm a relapse or the evolution of a lymphoma during
lymph nodes identified on CT scan have usually required treatment or follow-up. 7
open biopsy through a laparotomy incision. As technology 2. This study evaluated all patients undergoing laparoscopic
has improved, CT/ultrasound-guided fine-needle aspiration retroperitoneal lymph node biopsy from 2001 to 2007

World Journal of Laparoscopic Surgery, September-December 2010;3(3):139-143 139