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 supplements (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 (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
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 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.

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 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.

Related Information

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

ByHealthwise Staff
Primary Medical Reviewer Sarah Marshall, MD – Family Medicine
E. Gregory Thompson, MD – Internal Medicine
Kathleen Romito, MD – Family Medicine
Specialist Medical Reviewer Laura S. Dominici, MD – General Surgery,

Current as ofMay 3, 2017