Biopsies – why not?

Why are biopsies often contraindicated for lymphoedema patients?

Biopsies and lymphoedema care

Rebecka Blenntoft, expert human and equine lymphologist, explains why biopsies need to be considered very carefully in lymphoedema patients.

“I am often asked about whether biopsy is necessary in order to diagnose lymphatic disease. In human practice we don’t biopsy. This is because puncturing the skin is contraindicated (unless there is a distinct need, such as cancer diagnoses). Lymphatic disease means that any wounds will be slow to heal and a potential site for secondary infection.

In human lymphology diagnosis is made through taking a full case history, volume measurements, analysis of tissue quality, palpation and manual tests such as Stemmer’s sign. Advanced or challenging cases may be referred for lymphoscintigraphy, but most cases won’t require this.

With the lack of trained therapists and vets unable to perform the above level of patient assessment in equines it is perhaps understandable that some vets want to biopsy. If this is the case, then it may be useful to ask the vet what his or her treatment plan would be for CPL.”

Rebecka Blenntoft

Questions for vets

If your vet has advised they want to take a biopsy to diagnose CPL, here are some questions you can ask them, to enable better understanding from both vet and owner. Discuss whether it would be better to just treat as though it is CPL and monitor the legs carefully.

  1. Why is a biopsy necessary when there is not a conclusive diagnosis for CPL that can be achieved via biopsy, remembering that altered elastin metabolism is not specifically diagnostic of CPL?
  2. What do you hope to find?
  3. Do you know that is it contraindicated to biopsy lymphatic disease patients due to delayed wound healing and risk of secondary infection?
  4. Are you (the vet) willing to sign a disclaimer to state your veterinary practice is responsible for any fees incurred in the event of a secondary infection due to taking a biopsy from an immuno-compromised leg?
  5. Why do you feel you are not able to make a diagnosis based on the unique physical presentation? (Hyperkeratosis, oedematous skin folds and nodules on at least both hind legs and usually all four, being the major indicators.)
  6. If the biopsy leads you to suspect CPL, what care/treatment plan do you suggest?