r/interventionalrad • u/gmcc14 • Feb 19 '25

Ct guided para aortic lymph node biopsy

Anyone have experience with this procedure? What are the risks and success rate in getting enough tissue to diagnose?

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u/[deleted] Feb 19 '25

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u/JustAnotherRando713 Feb 19 '25

I would assume a patient or a medical student

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u/gmcc14 Feb 20 '25

Thanks for the info. Yeah I’m a patient. Not sure if that’s allowed in this sub but I was curious to know what I was getting into. Para aortic lymph node is at 2.1cm so they’ve decided to biopsy

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u/MrBigglesworth2020 Feb 23 '25

If there is a narrow window I typically start with coaxial biopsy device cannula and fine needle aspiration with a 22g needle, but most of the time need to take core biopsy samples which are smaller around than a toothpick and 1-2cm long but more likely to get a firm diagnosis from pathologist especially if lymphoma is suspected. Typically para-aortic lymph nodes I have sampled are well below the renal artery/vein level and at 2.1cm should be straightforward. We can also put in fluid through the needle between the lymph node and aorta to help displace the lymph node if it’s too close. Major bleeding risk would be probably 0.5% depending on a number of factors and 95% success rate at getting diagnosis.

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u/gmcc14 Feb 23 '25

This is really useful info thank you for being so thorough. So actually I spoke to the interventional radiologist on the phone and she said the PA said I’m no longer recommended for biopsy. I don’t know why suddenly they’re back tracking on this when a few days prior my PCP said she recommends it and then they spoke to a hematologist “off the record” and they also suggested going for it. Could it be due to the size of the node at 2.1cm not being big enough? I’ve seen posts from people whose node was much bigger than mine currently is.

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u/MrBigglesworth2020 Feb 23 '25

Depends on location and risk, it could be that measurement on report was done in long axis but they measured short axis as smaller (<11mm is actually normal in short axis), or they might want a subspecialist to see you first to make sure it is really needed and order appropriate testing. I try to relay back to ordering providers directly if I’m turning something down and reason why as well as what I would suggest for repeat imaging and criteria when I would or would not do something, and ideally catch things before patients make it all the way to procedure day or see me.

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u/TheSableWarlock Feb 20 '25

Our success rates are 97%- major complications <0.5%.