Lymphoma Diagnosis: Biopsy Now or Later?
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I’m worried my husband might have lymphoma. One month ago enlarged mesenteric nodes were found on his abdominal/pelvic CT scan. A few days after this, he had a PET scan in which an abdominal node showed hypermetabolic activity (maximum standard uptake value of 4.6). His doctor gave him two antibiotics for 10 days, and ordered another CT scan done a month after the first one. This one showed several enlarged mesenteric lymph nodes – the largest and most heterogeneous had a maximum dimension of 1.8 cm. (this one was not changed from previous CT scan). There was a node that measured 9 by 8 mm which had previously measured 6 mm. There was also a smaller lymph node that showed an increase in size. He was sent to an oncologist who says to wait on the biopsy and have another CT scan in two to three months. Please tell me what you think we should do. Should we ask for a biopsy sooner? Thanks so much.
Certainly the enlarging lymph nodes, which show activity on the PET scan, are worrisome for the possibility of lymphoma, but your husband will need a biopsy for a definitive diagnosis. Given that the lymph nodes are not growing rapidly — and if this is lymphoma, it is likely a slow-growing type which may not require treatment for some time — a repeat scan in two to three months is not unreasonable.
If it hasn't been done already, it may make sense for your husband to have a CT scan of the chest to look for evidence of abnormal lymph nodes there. In addition, he should also have routine blood tests, though the results may be completely normal even if the lymph nodes represent lymphoma.
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