Lymph node biopsy
Biopsy - lymph nodes; Open lymph node biopsy; Fine needle aspiration biopsy; Sentinel lymph node biopsyA lymph node biopsy is the removal of lymph node tissue for examination under a microscope.
The lymph nodes are small glands that make white blood cells (lymphocytes), which fight infection. Lymph nodes may trap the germs that are causing an infection. Cancer can spread to lymph nodes.
Cancer
Cancer is the uncontrolled growth of abnormal cells in the body. Cancerous cells are also called malignant cells.
Read Article Now Book Mark ArticleHow the Test is Performed
A lymph node biopsy is often done in an operating room in a hospital or at an outpatient surgical center. The biopsy may be done in different ways.
An open biopsy is surgery to remove all or part of the lymph node. This is usually done if there is a lymph node that can be felt on exam. This can be done with local anesthesia (numbing medicine) injected into the area, or under general anesthesia. The procedure is typically done in the following way:
General anesthesia
General anesthesia is treatment with certain medicines that puts you into a deep sleep so you do not feel pain during surgery. After you receive the...
Read Article Now Book Mark Article- You lie on the exam table. You may be given medicine to calm you and make you sleepy or you may have general anesthesia, which means you are asleep and pain-free.
- The biopsy site is cleansed.
- A small surgical cut (incision) is made. The lymph node or part of the node is removed.
- The incision is closed with stitches and a bandage or liquid adhesive is applied.
- An open biopsy may take 30 to 45 minutes.
For some cancers, a special way of finding the best lymph node to biopsy is used. This is called sentinel lymph node biopsy, and it involves:
A tiny amount of a tracer, either a radioactive tracer (radioisotope) or a blue dye or both, is injected at the tumor site or in the area of the tumor.
The tracer or dye flows into the nearest (local) node or nodes. These nodes are called the sentinel nodes. The sentinel nodes are the first lymph nodes to which a cancer may spread.
The sentinel node or nodes are removed.
Lymph node biopsies in the belly may be performed with a laparoscope. This is a small tube with a light and camera that is inserted through a small incision in the abdomen. One or more incisions will be made and tools will be inserted to help remove the node. The lymph node is located and part or all of it is removed. This is usually performed under general anesthesia, which means the person having this procedure will be asleep and pain-free.
After the sample is removed, it is sent to the laboratory for examination.
A needle biopsy involves inserting a needle into a lymph node. This type of biopsy can be performed by a radiologist with local anesthesia, using ultrasound or CT scan to find the node. It can also be performed by a surgeon without imaging if the lymph node can be felt.
Ultrasound
Ultrasound uses high-frequency sound waves to make images of organs and structures inside the body.
Read Article Now Book Mark ArticleCT scan
A computed tomography (CT) scan is an imaging method that uses x-rays to create pictures of cross-sections of the body. Related tests include:Abdomin...
Read Article Now Book Mark ArticleHow to Prepare for the Test
Tell your surgeon:
- If you are pregnant
- If you have any allergies to medicines
Allergies to medicines
Drug allergies are a group of symptoms caused by an allergic reaction to a drug (medicine).
Read Article Now Book Mark Article - If you have bleeding problems
- What medicines you are taking (including any supplements or herbal remedies)
Your surgeon may ask you to:
- Stop taking any blood thinners, such as aspirin, heparin, warfarin (Coumadin), or clopidogrel (Plavix) as directed
- Not eat or drink anything after a certain period of time before the biopsy
- Arrive at a certain time for the procedure
How the Test will Feel
When the local anesthetic is injected, you will feel a prick and a mild stinging. The biopsy site will be sore for a few days after the test.
After an open or laparoscopic biopsy, the pain is usually mild and you can easily control it with an over-the-counter pain medicine. You may also notice some bruising or fluid leaking for a few days. Follow instructions for taking care of the incision. While the incision is healing, avoid any type of intense exercise or heavy lifting that causes pain or discomfort. Ask your surgeon for specific instructions about what activities you can do.
Why the Test is Performed
The test is used to diagnose cancer, sarcoidosis, or an infection (such as tuberculosis):
Sarcoidosis
Sarcoidosis is a disease in which inflammation occurs in the lymph nodes, lungs, liver, eyes, skin, and/or other tissues.
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When you or your health care provider feel swollen lymph glands and they do not go away
Swollen lymph glands
Lymph nodes are present throughout your body. They are an important part of your immune system. Lymph nodes help your body recognize and fight germ...
Read Article Now Book Mark Article - When abnormal lymph nodes are present on a mammogram, ultrasound, CT, or MRI scan
Mammogram
A mammogram is an x-ray picture of the breasts. It is used to evaluate some breast symptoms and to find breast cancer in women with no symptoms....
Read Article Now Book Mark ArticleMRI scan
A magnetic resonance imaging (MRI) scan is an imaging test that uses powerful magnets and radio waves to create pictures of the body. It does not us...
Read Article Now Book Mark Article - For some people with cancer, such as breast cancer or melanoma, to see if the cancer has spread (sentinel lymph node biopsy or needle biopsy by a radiologist)
Breast cancer
Breast cancer is cancer that starts in the tissues of the breast. There are two main types of breast cancer:Ductal carcinoma starts in the tubes (du...
Read Article Now Book Mark ArticleMelanoma
Melanoma is the most dangerous type of skin cancer. It is also the rarest. It is the leading cause of death from skin disease. Other common types o...
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The results of the biopsy help your provider decide on further tests and treatments.
Normal Results
If a lymph node biopsy does not show any signs of cancer, it is more likely that other lymph nodes nearby are also cancer-free. This information can help the provider decide about further tests and treatments.
What Abnormal Results Mean
Abnormal results may be due to many different conditions, from very mild infections to cancer.
For example, enlarged lymph nodes may be due to:
-
Cancers (breast, lung, oral)
Lung
Lung cancer is cancer that starts in the lungs. The lungs are located in the chest. When you breathe, air goes through your nose, down your windpipe...
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- Cancer of the lymph tissue (Hodgkin or non-Hodgkin lymphoma)
Hodgkin
Hodgkin lymphoma is a cancer of lymph tissue. Lymph tissue is found in the lymph nodes, spleen, liver, bone marrow, and other sites.
Read Article Now Book Mark ArticleNon-Hodgkin
Non-Hodgkin lymphoma (NHL) is cancer of the lymph tissue. Lymph tissue is found in the lymph nodes, spleen, and other organs of the immune system. W...
Read Article Now Book Mark Article - Infection (tuberculosis, cat scratch disease)
Cat scratch disease
Cat-scratch disease is an infection with bartonella bacteria. It is transmitted by cat scratches, cat bites, or flea bites.
Read Article Now Book Mark Article - Inflammation of lymph nodes and other organs and tissues (sarcoidosis)
Risks
Lymph node biopsy may result in any of the following:
- Bleeding
- Infection (in rare cases, the wound may get infected and you may need to take antibiotics)
- Nerve injury if the biopsy is done on a lymph node close to nerves (the numbness usually goes away in a few months)
References
Dinulos JGH. Nevi and malignant melanoma. In: Dinulos JGH, ed. Habif's Clinical Dermatology. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 22.
National Cancer Institute website. Sentinel lymph node biopsy. www.cancer.gov/about-cancer/diagnosis-staging/staging/sentinel-node-biopsy-fact-sheet. Updated June 25, 2019. Accessed June 6, 2024.
Lymphatic system - illustration
The lymphatic system filters fluid from around cells. It is an important part of the immune system. When people refer to swollen glands in the neck, they are usually referring to swollen lymph nodes. Common areas where lymph nodes can be easily felt, especially if they are enlarged, are the groin, armpits (axilla), above the clavicle (supraclavicular), in the neck (cervical), and the back of the head just above hairline (occipital).
Lymphatic system
illustration
Lymph node metastases, CT scan - illustration
A CT scan of the middle abdomen showing a large tumor mass due to metastasis (spreading cancer) in abdominal lymph nodes.
Lymph node metastases, CT scan
illustration
Lymphatic system - illustration
The lymphatic system filters fluid from around cells. It is an important part of the immune system. When people refer to swollen glands in the neck, they are usually referring to swollen lymph nodes. Common areas where lymph nodes can be easily felt, especially if they are enlarged, are the groin, armpits (axilla), above the clavicle (supraclavicular), in the neck (cervical), and the back of the head just above hairline (occipital).
Lymphatic system
illustration
Lymph node metastases, CT scan - illustration
A CT scan of the middle abdomen showing a large tumor mass due to metastasis (spreading cancer) in abdominal lymph nodes.
Lymph node metastases, CT scan
illustration
Review Date: 5/29/2024
Reviewed By: Debra G. Wechter, MD, FACS, General Surgery Practice Specializing in Breast Cancer, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.