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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, scratch, insect bite, tattoo, 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 aspiration 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

Tell your doctor if you:

  • Are taking any medicines or natural health products (such as vitamins or herbal remedies).
  • Are allergic to any medicines, including anesthetics.
  • Are allergic to latex.
  • Take a blood thinner, or if you have had bleeding problems.
  • Are or might be pregnant.

You will be asked to sign a consent form that says you understand the risks of the test and agree to have it done.

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 .

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 cancelled. 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 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 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.

Your doctor numbs the area where the needle will be inserted. Once the area is numb, the needle is put through the skin and into the lymph node. You must lie still while the biopsy is done. The biopsy sample is sent to a lab to be looked at under a microscope.

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.

Core needle biopsy

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

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.

Your doctor numbs the area 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.

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 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.

You will lie on an examination table and your body will be positioned to allow the doctor to take the biopsy sample. 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.

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. Fluid may collect near the biopsy site. Fluid may also leak from the biopsy site. You can use an ice pack or take an over-the-counter pain medicine (not aspirin) to help relieve swelling and mild pain. You may notice some numbness on the back of your upper arm. 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.

After the biopsy

Call your doctor immediately if:

  • Your pain lasts longer than a week.
  • You have signs of infection. These signs may include:
    • Increased pain, swelling, redness, or warmth around the site.
    • Red streaks spreading from the site.
    • Drainage of pus from the area.
    • Fever.

You may have numbness in the skin 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 in your arm or hand, or if the skin on your arm or hand feels tighter than normal, be sure to contact your doctor.

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 colour the cells and make problems more visible.

Lymph node biopsy

Normal:

The lymph node has normal numbers of lymph node cells.

The structure of the lymph node and the appearance of the cells in it are 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's lymphoma, or may have spread from other sites, such as in metastatic breast cancer.

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 teenagers 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 lymph nodes. 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. To learn more, see the topic Sentinel Lymph Node Biopsy.
  • 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. To learn more, see the topic 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. To learn more, see the topic Mediastinoscopy.

References

Other Works Consulted

  • Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders.
  • Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.
  • Morrow M, et al. (2015). Malignant tumors of the breast. In VT DeVita Jr et al., eds., DeVita, Hellman, and Rosenberg's Cancer Principles and Practices of Oncology, 10th ed., pp. 1117–1156. Philadelphia: Walters Kluwer.

Credits

Current as of:
April 29, 2020

Author: Healthwise Staff
Medical Review:
Sarah Marshall MD - Family Medicine
Anne C. Poinier MD - Internal Medicine
E. Gregory Thompson MD - Internal Medicine
Adam Husney MD - Family Medicine
Kathleen Romito MD - Family Medicine
C. Dale Mercer MD, FRCSC, FACS - General Surgery
Laura S. Dominici MD - General Surgery, Breast Surgical Oncology