Lymph node biopsy and needle biopsy
Question: Dr. Richards, Our old lab dog saga continues...We, both my husband and I scheduled a visit with our vet to discuss our concerns over the continued use of Prednisone to treat liver dysfunction following heartworm treatment. I felt our dog had ascites but was not certain and wanted her checked out by our vet. He palpated her abdomen and under her neck. After completing his exam he said she does indeed have ascites but worse yet he felt a 5 cm mass on the right side of her neck. He believes it is a swollen lymph node which indicates lymphosarcoma. What a jolt! He explained our options...needle biopsy if we wanted to know for certain or monitor the size of the mass over time. If the mass grew he felt certain of his diagnosis. He also suggested she was not a candidate for chemotherapy. We have opted to wait and see, however, this is devastating news. When asked about prognosis he said 4 to 5 months. I remember hearing the word euthanasia but for the life of me I can't remember what was said. He did decrease the Prednisone to 30mg every other day for 1 week then 20mg every other day for 1 month which he hopes will reduce the side affects. He wants to see her in 2 weeks to re-evaluate. It seems every time we visit the Vet's office we find a new problem. All I want for this dog is happiness in her final years. Again, I would appreciate your views. Thank you in advance for your help. Pat.
A needle biopsy is a very simple test to perform and it doesn't hurt any more than an injection. We do needle biopsy of lymph nodes pretty frequently. We read the slides in our office and send a slide to a veterinary pathologist who does cytologic exams, as well. We usually use the vet school for this but there are commercial labs that offer the service. I would strongly advise going ahead with this test rather than waiting. Even removing a lymph node for biopsy is pretty simple, so if the needle biopsy is suspicious I wouldn't hesitate to do that, either. Even if you aren't going to consider chemotherapy it can help a lot to have a good idea of what is going on. It makes it a lot easier to figure out whether to continue prednisone (since that helps with lymphoma when chemotherapy isn't an option) and it may indicate another problem that can be corrected.
Even though I think I am reasonably good at reading the smears from lymph node aspirates, I always send them to a pathologist unless the client refuses to let me. It is pretty inexpensive and makes a very qualified second opinion available to us.
Good luck with all of this.
Mike Richards, DVM
Michael Richards, D.V.M. co-owns a small animal general veterinary practice in rural tidewater Virginia. Dr. Richards graduated from Iowa State University's College of Veterinary Medicine in 1979, and has been in private practice ever since. Dr. Richards has been the director of the PetCare Forum...