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Malignant involvement of lymph nodes

# Which  is  the  preferred  method  of  biopsy  in  case  of  a  malignant  involvement  of  lymph  node? 
a. Fine needle  aspiration 
b. Incisional  biopsy
c. Excisional biopsy 
d. No  biopsy



The correct answer is A. Fine needle aspiration.

Fine-needle aspiration (FNA) is a diagnostic procedure used to investigate lumps or masses. In this technique, a thin (23–25 gauge (0.52 to 0.64 mm outer diameter)), hollow needle is inserted into the mass for sampling of cells that, after being stained, are examined under a microscope (biopsy). The sampling and biopsy considered together are called fine-needle aspiration biopsy (FNAB) or fine-needle aspiration cytology (FNAC) (the latter to emphasize that any aspiration biopsy involves cytopathology, not histopathology). Fine-needle aspiration biopsies are very safe minor surgical procedures. Often, a major surgical (excisional or open) biopsy can be avoided by performing a needle aspiration biopsy instead, eliminating the need for hospitalization. In 1981, the first fine-needle aspiration biopsy in the United States was done at Maimonides Medical Center. Today, this procedure is widely used in the diagnosis of cancer and inflammatory conditions.

Aspiration is safer and far less traumatic than an open biopsy; complications beyond bruising and soreness are rare. However, the few problematic cells can be too few (inconclusive) or missed entirely (a false negative).

This type of sampling is performed for one of two reasons:
- A biopsy is performed on a lump or a tissue mass when its nature is in question.
- For known tumors, this biopsy is performed to assess the effect of treatment or to obtain tissue for special studies.

When the lump can be felt, the biopsy is usually performed by a cytopathologist or a surgeon. In this case, the procedure is usually short and simple. Otherwise, it may be performed by an interventional radiologist, a doctor with training in performing such biopsies under x-ray or ultrasound guidance. In this case, the procedure may require more extensive preparation and take more time to perform.

Also, fine-needle aspiration is the main method used for chorionic villus sampling, as well as for many types of body fluid sampling.

It is also used for ultrasound-guided aspiration of breast abscess, of breast cysts, and of seromas.

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