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. See a picture of lymph nodes and of the immune system.

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, scratch, insect bite, 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.

• A fine-needle aspiration biopsy puts a thin needle into the lymph node and removes cells to look at. A needle biopsy is done to check the cause of a big lymph node.
• A core needle biopsy uses a needle fitted with a special tip. The needle goes through the skin to the lymph node to take a sample of tissue about the size of a pencil lead.
• An open biopsy makes a cut in the skin and removes the 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

Tell your doctor if you:

• Are taking any medicines.
• Are allergic to any medicines, including anesthetics.
• Are allergic to latex.
• Have any bleeding problems or take blood thinners, such as aspirin, heparin, warfarin (Coumadin), enoxaparin sodium (Lovenox), or clopidogrel bisulfate (Plavix).
• Are or might be pregnant.

You will be asked to sign a consent form. Talk to your doctor about any concerns you have regarding the need for the biopsy, its risks, how it will be done, or what the results will mean. To help you understand the importance of the biopsy, fill out the medical test information form (What is a PDF document?).

If you take a blood thinner, you will probably need to stop taking it for a week before the biopsy.

If a lymph node biopsy will be done under local anesthesia, you do not need to do anything else to prepare for the biopsy.

If the biopsy will be done under general anesthesia, follow the instructions exactly about when to stop eating and drinking, or your surgery may be canceled. If your doctor has instructed you to take your medicines on the day of surgery, do so using only a sip of water. An intravenous line (IV) will be put in your arm, and a sedative medicine will be given before the biopsy. Arrange for someone to drive you home if you are going to have general anesthesia or will be given a sedative.

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

How It Is Done

Fine-needle aspiration biopsy

A needle biopsy of a big lymph node near the skin is usually done by a hematologist, a radiologist, or a general surgeon. A needle biopsy of a lymph node deeper within the body is usually done by a radiologist using a CT scan or ultrasound to help guide the needle. The biopsy may be done in a surgery clinic or the hospital.

You will need to take off all or most of your clothes (you may be allowed to keep on your underwear if it does not interfere with the biopsy). You will be given a cloth or paper covering to use during the biopsy.

Your doctor numbs the area of your breast where the needle will be inserted. Once the area is numb, the needle is put through the skin and into the lymph node. The biopsy sample is sent to a lab to be looked at under a microscope. 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. A fine-needle aspiration biopsy takes about 5 to 15 minutes.

See a picture of a fine-needle lymph node biopsy.

Core needle biopsy

A core needle biopsy is usually done by a general surgeon or radiologist.

You will need to take off all or most of your clothes (you may be allowed to keep on your underwear if it does not interfere with the biopsy). You will be given a cloth or paper covering to use during the biopsy.

Your doctor numbs the area of your breast where the needle will be inserted. Once 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. 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. A core needle biopsy takes about 20 minutes.

See a picture of a core needle lymph node biopsy.

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 for lymph node dissection, you may have general anesthesia.

You will need to take off all or most of your clothes (you may be allowed to keep on your underwear if it does not interfere with the biopsy). You will be given a cloth or paper covering to use during the biopsy. Your hands may be at your sides or raised above your head (depending on which position makes it easiest to find the lymph node).

You will lie on an examining table and the skin over the biopsy site will be cleaned with a special soap. The area is covered with a sterile sheet. 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. You can usually return to your normal activities the next day.

An open biopsy usually takes from 30 to 60 minutes. If you have had a lymph node dissection to remove cancer, the surgery may take longer.

See a picture of an open lymph node biopsy.

How It Feels

You will feel only a quick sting from the needle if you have a local anesthesia to numb the biopsy area. You may feel some pressure when the biopsy needle is put in. After a fine-needle aspiration biopsy or core needle biopsy, the site may be tender for 2 to 3 days. You also may have a bruise around the site.

If you have general anesthesia for an open lymph node biopsy, you will not be awake during the biopsy. 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.

For 1 to 2 days after an open lymph node biopsy, you may feel tired. You may also have a mild sore throat if a tube was used to help you breathe during the biopsy. Using throat lozenges and gargling with warm salt water may help with the sore throat.

After an open biopsy, the area may feel tender, firm, swollen, and bruised. You may have fluid collect near the biopsy site. You may also have fluid leak from the biopsy site. The tenderness should go away in about a week, and the bruising usually fades within 2 weeks. But the firmness and swelling may last for 6 to 8 weeks. Do not do any heavy lifting or other activities that stretch or pull the muscles around the area.

Risks

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

Call your doctor immediately if:

• Your pain lasts longer than a week.
• You have redness, a lot of swelling, bleeding, or pus from the biopsy site.
• You have a fever.
• There is fluid buildup in the area where the lymph node was taken out. This occurs most often when removing the lymph nodes that run in a line from under the arm to the collarbone (axillary lymph nodes). This can happen immediately after surgery or even months or years later. Most people who have a lymph node biopsy do not have a problem with fluid buildup.
• Numbness in the skin near the biopsy site. This may be caused by nerve damage.

Results

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. Test results from a lymph node biopsy 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 and make problems more visible.

What Affects the Test

A needle biopsy takes tissue from a small area, so there is a chance that a cancer may be missed.

What To Think About

• Cancer that begins in the lymph nodes (lymphoma) is the most common form of cancer in teens and young adults. Even though most enlarged lymph nodes are not caused by lymphoma, it is important to have enlarged lymph nodes that do not go away checked by your doctor.
• Looking at a lymph node under a microscope does not always give a clear diagnosis. In these cases, other tests are needed to find the cause of the problem.
• If an infection is present, a culture of the lymph node may be done to find what is causing the infection.
• Sometimes a lymph node sample is treated with special markers (antibodies) that attach to abnormal cells. Marker studies may be done to find lymphomas and other types of cancer.
• Sentinel node biopsy may be done instead of removing an entire group of axillary lymph nodes (axillary lymph node dissection). A sentinel node is the first lymph node to which a certain cancer would travel. In some cases, there may be more than one sentinel node. Sentinel node biopsy takes out less tissue, and it does not cause as many problems with lymphedema.
  • Before a sentinel node biopsy is done, a special test is done to find which lymph nodes are involved. A radioactive tracer is put into the area where the cancer is found and a special camera takes pictures of the lymph nodes. A blue dye may also be used during a sentinel node biopsy. The first lymph nodes to show the tracer are the sentinel nodes. The dye may cause your skin to look blue or green for several days after the biopsy. It also makes your urine green for 24 hours.
  • The sentinel nodes are removed and looked at under a microscope for cancer. If the sentinel nodes have cancer cells, a more extensive lymph node dissection is usually done to find out how far the cancer has spread.
• Some lymph node biopsies may be done using special tools in which a thin lighted tube is used to take out a lymph node:
  • Laparoscopy uses a lighted viewing scope (laparoscope) to look inside the belly and take a biopsy of lymph nodes. It may be done to find cancer that has spread in the belly. For more information, see the medical test Laparoscopy.
  • Mediastinoscopy uses a lighted viewing scope (mediastinoscope) to look inside the chest. The scope can be used to take out samples of lymph nodes in the chest to see if lung cancer has spread to the lymph nodes. For more information, see the medical test Mediastinoscopy.

References

Other Works Consulted

• Brydges G, et al. (2003). Handbook of Diagnostic Tests, 3rd ed. Philadelphia: Lippincott Williams and Wilkins.

Credits