Lymph Node Biopsy

Introduction :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).

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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. You may click see an illustration of lymph nodes and the immune system.

Lymph nodes in healthy people are usually hard to feel. However, 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.

The nodes produce and harbor infection-fighting white blood cells (lymphocytes) that attack both infectious agents and cancer cells. Cancer, infection, and some other diseases can change the appearance of lymph nodes. For that reason, your doctor may ask a surgeon to remove lymph nodes, to be examined microscopically for evidence of these problems.

Usually, one or more entire lymph nodes are removed and examined under the microscope by a pathologist. On occasion, the doctor does a needle biopsy to remove a portion of a lymph node to see whether a cancer already diagnosed has spread to that point.

How it is done: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 yourself for the test:

Tell your doctor if you:

*Are taking any medicines.

*Are allergic to any medicines, including anesthetics.

*Are allergic to latex.

* You’re taking NSAIDs or any medications that might cause bleeding.

* You have a condition that bleeds easily such as an ulcer in your stomach or small intestine, or if you’re pregnant.

*Have any bleeding problems or take blood thinners, such as aspirin, heparin, warfarin (Coumadin), enoxaparin sodium (Lovenox), or clopidogrel bisulfate (Plavix).

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 indicate. To help you understand the importance of the biopsy, fill out the medical test information.

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 is done under local anesthesia, you do not need to do anything else to prepare for the biopsy.

If the biopsy is done under general anesthesia, do not eat or drink anything for 8 to 12 hours before the biopsy. An intravenous line (IV) is put in your arm, and a sedative medication is given about an hour before the biopsy. Arrange for someone to drive you home if you have general anesthesia or are given a sedative.

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

How It Is Done:
This depends on the location of the lymph nodes to be biopsied. Fortunately many lymph nodes, such as those in your neck, armpits, and groin, are found close to the surface of the skin. These can all be reached through an incision in the skin.

Some lymph nodes are located deeper in your body, such as in the middle of your chest. To reach them, your doctor may insert a tube-like viewing instrument (a scope) through a slit in the skin into the target area to see the lymph nodes, and then remove them with tiny surgical scissors located at the end of the scope. Sometimes removing lymph nodes for microscopic examination requires surgery.

When lymph nodes beneath the skin are biopsied, you lie on an examining table. The doctor cleans the skin at the biopsy site and injects a local anesthetic. Next, the doctor makes a small incision in the skin and the tissue just beneath it until he or she can see the lymph node and cut it out. Following such a biopsy, it’s normal to bleed slightly. After applying pressure to the incision site to stop the bleeding, the doctor will cover the area with a bandage. You’ll usually be able to go home within several hours.When a biopsy involves inserting a scope, or surgery, general anesthesia may be required.

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 your skin 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.

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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.

You may click to see an illustration 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 your skin 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.

You may click to see an illustration 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.

You may click to see an illustration 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 skin. 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 from the tube that 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. However, 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.

Risk Factors:

The biopsy site will feel tender for a few days. There’s a slight risk of infection or bleeding. Depending on the location of the lymph node being removed, there is a slight risk of blood vessel or nerve damage. 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 (lymphedema). 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 lymphedema.

*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.

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.

How long is it before the result of the test is known?
Results will probably be ready in several days.

Resources:
https://www.health.harvard.edu/fhg/diagnostics/lymph-node-biopsy.shtml
http://www.webmd.com/cancer/lymph-node-biopsy

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