Role of laparoscopic biopsy in the management of intra-abdominal lymphadenopathy

Intra- or retroperitoneal lymphadenopathy is often a diagnostic challenge Surgical radiology techniques, such as fine needle aspiration and core needle biopsy, are useful but frequently inadequate and sometimes difficult and dangerous to perform. Deep abdominal lymph node sampling can be done laparoscopically, avoiding the risks of a large laparotomy. The objective of this study was to assess the safety, efficacy and diagnostic accuracy of laparoscopic biopsy, when compared with historic needle biopsy studies reported in the literature. From January 1999 to June 2001, 19 laparoscopic biopsies were performed for 18 patients with intra- or retroperitoneal lymphadenopathy. Clinical and technical characteristics and histopathological findings for each laparoscopic biopsy performed were analysed retrospectively. In 15 patients the biopsy was performed in order to achieve the diagnosis. In the other 4 cases laparoscopic biopsy was required to confirm a relapse or the evolution of a lymphoma during treatment or follow-up. The conversion rate was nil. There were no major complications. None of the patients died postoperatively. The average hospital stay was 2.4 days (range: 1-6 days). In 94% of the cases, the laparoscopic biopsy supplied the necessary information for the correct diagnosis and consequent therapeutic decisions. These results confirm that laparoscopic biopsy is safe and effective. This procedure has a higher diagnostic yield than the percutaneous techniques and should be proposed as the gold standard biopsy approach in all cases of deep abdominal lymphadenopathy.