Lymph Node Biopsy

Test Overview

A lymph node biopsy removes lymph node tissue to be looked at under a microscope for signs of infection or a disease, such as cancer. Other tests may also be used to check the lymph tissue sample, including a culture, genetic tests, or tests to study the body's immune system (immunological tests).

Lymph nodes are part of the immune system. They are found in the neck, behind the ears, in the armpits, and in the chest, belly, and groin.

Lymph nodes in healthy people are usually hard to feel. But lymph nodes in the neck, armpit, or groin can get bigger and become tender. Swollen lymph nodes usually mean an infection. But the swelling can also be caused by a cut, a scratch, an insect bite, a tattoo, a drug reaction, or cancer.

There are several ways to do a lymph node biopsy. The lymph node sample will be looked at under a microscope for problems.

• Fine needle biopsy. Your doctor inserts a thin needle into a lymph node and removes a sample of cells.
• Core needle biopsy. Your doctor inserts a needle with a special tip and removes a sample of tissue about the size of a grain of rice.
• Open (surgical) biopsy. Your doctor will make a small cut in the skin and remove a lymph node. If more than one lymph node is taken, the biopsy is called a lymph node dissection. Open biopsy and lymph node dissection let your doctor take a bigger sample than a needle biopsy.

Why It Is Done

Lymph node biopsy is done to:

• Check the cause of enlarged lymph nodes that do not return to normal size on their own.
• Check the cause of symptoms, such as an ongoing fever, night sweats, or weight loss.
• Check to see if a known cancer has spread to the lymph nodes. This is called staging and is done to plan cancer treatment.
• Remove cancer.

How To Prepare

Procedures can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for your procedure.

Preparing for the procedure

• If the biopsy will be done under general anesthesia, follow the instructions exactly about when to stop eating and drinking, or your biopsy may be canceled. If your doctor has instructed you to take your medicines on the day of the biopsy, do so using only a sip of water.
• If a lymph node biopsy will be done under local anesthesia, you don't need to do anything else to prepare for the biopsy.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your test. Your doctor will tell you if you should stop taking any of them before the test and how soon to do it.
• If you take aspirin or some other blood thinner, ask your doctor if you should stop taking it before your surgery. Make sure that you understand exactly what your doctor wants you to do. These medicines increase the risk of bleeding.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.
• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.

Other tests, such as blood tests or X-rays, may be done before the lymph node biopsy.

How It Is Done

A lymph node biopsy may be done in a surgery clinic or the hospital.

You may need to take off all or some of your clothes. If needed, you will be given a cloth or paper covering to use during the biopsy.

Fine needle biopsy

In a fine needle lymph node biopsy, your doctor numbs the area where the needle will be inserted. When the area is numb, the needle is put through the skin and into the lymph node to remove a sample of cells. You must lie still while the biopsy is done.

The needle is then removed. Pressure is put on the needle site to stop any bleeding. A bandage is put on.

The biopsy sample is sent to a lab to be looked at under a microscope.

Core needle biopsy

In a core needle lymph node biopsy, your doctor numbs the area where the needle will be inserted. When the area is numb, a small cut is made in the skin. A needle with a special tip is put through the skin and into the lymph node to remove a sample of tissue. You must lie still while the biopsy is done.

The needle is then removed. Pressure is put on the needle site to stop any bleeding. A bandage is put on.

Open biopsy and lymph node dissection

An open biopsy of a lymph node is done by a surgeon. For a lymph node near the surface of the skin, the biopsy site is numbed with local anesthetic. For a lymph node deeper in the body or if more than one lymph node will be taken (lymph node dissection), you may have general anesthesia. That means you will not be awake during the biopsy.

An intravenous line (I.V.) will be put in your arm, and a sedative medicine will be given before the biopsy.

A small cut will be made so the whole lymph node or a slice of it can be taken out.

Stitches are used to close the skin, and a bandage is put on. You will be taken to a recovery room until you are fully awake. After you wake up, the area may be numb from a local anesthetic that was put into the biopsy site. You will also feel sleepy for several hours.

How long the test takes

• A fine needle biopsy takes about 5 to 15 minutes.
• A core needle biopsy takes about 20 minutes.
• An open biopsy usually takes from 30 to 60 minutes. If you've had a lymph node dissection to remove cancer, the surgery may take longer.

How It Feels

You will feel only a quick sting from the needle if you have a local anesthesia to numb the biopsy area. If you have a core needle biopsy, you may feel some pressure when the biopsy needle is put in.

You may have general anesthesia if your lymph node is deeper in the body or the biopsy is part of a larger surgery. If so, you won't feel your biopsy at all.

Risks

There is a chance of an infection at the biopsy site. An infection can be treated with antibiotics.

Your skin may feel numb near the biopsy site. This is common.

After surgery you may have a buildup of fluid where lymph nodes were removed. This fluid is called seroma. Your body will reabsorb the fluid, but it may take some time. Or your doctor may decide to drain the fluid. If the area becomes painful or shows signs of infection, such as redness, warmth, or tenderness, call your doctor right away.

Having lymph nodes removed may increase your chance of getting lymphedema. This can happen months after you have the surgery. If you notice swelling or if your skin feels tighter than normal, be sure to contact your doctor.

Results

Results are usually available within a few days. Finding some types of infections may take longer.

The lymph node sample is usually treated with special dyes (stains) that color the cells so problems can be clearly seen.

Normal

• The lymph node has normal numbers of lymph node cells.
• The structure of the lymph node and the cells look normal.
• No signs of infection are present.

Abnormal

• Signs of infection, such as mononucleosis (mono) or tuberculosis (TB), may be present.
• Cancer cells may be present. Cancer may begin in the lymph node, such as Hodgkin lymphoma, or may have spread from other sites, such as in metastatic breast cancer.