Lymph Node Biopsy

What is a lymph node biopsy?

A lymph node biopsy is a procedure to check your lymph nodes for signs of disease like cancer. For this type of biopsy, a provider (usually a surgeon or radiologist) removes all or part of a lymph node. A different provider, called a pathologist, tests the tissue in a lab.

Your lymph nodes are pea-sized organs located throughout your body that filter harmful substances. The fluid (lymph) that drains from your cells and tissue passes through your lymph nodes. If the lymph contains germs, they can get trapped in your lymph nodes. Likewise, lymphoma starts in your lymph nodes, and other types of cancer can spread to them.

Testing lymph node tissue can expose these microscopic signs of disease. Lymph node biopsy results help healthcare providers diagnose conditions, determine their seriousness and then decide on the best treatments.

When would a doctor biopsy a lymph node?

Your provider may order a lymph node biopsy to:

• Diagnose and stage cancer. Providers perform lymph node biopsies to diagnose cancer and see if it’s spread beyond the primary tumor. This information helps your provider plan treatment. It also provides insight into what outcomes you can expect from treatment (prognosis).
• Determine what’s causing a swollen lymph node. Lymph nodes often swell when you’re sick. Most causes (like a cold) are obvious. But you may need a biopsy if the swelling doesn’t go away and your provider doesn’t know why. You may have a serious infection or an immune system condition like sarcoidosis.

Your provider will explain why they’re doing the biopsy so you understand what conditions they’re testing for.

Types of lymph node biopsies

Types include:

• Sentinel node biopsy: This type can show if cancer has spread beyond the primary tumor. During the procedure, a provider locates the lymph nodes closest to the tumor (sentinel lymph nodes) and removes them to test for cancer cells.
• Needle biopsy: This type of lymph node biopsy allows providers to remove lymph node tissue from areas they can access through your skin. A fine-needle aspiration uses a tiny needle with a hollow center that collects fluid and cells. A core needle biopsy uses a slightly larger needle that collects a sample of intact tissue.
• Open biopsy: You may need an open biopsy if your provider can’t easily access the lymph node through your skin. A provider makes a cut (incision) to access your lymph node and removes all of it (excisional biopsy) or part of it (incisional biopsy).

Sometimes, providers refer to the type of lymph node biopsy based on where the lymph nodes are. The major ones are:

• Axillary (armpit) lymph node biopsy.
• Cervical (neck) lymph node biopsy.
• Inguinal (groin) lymph node biopsy.

What should I expect before the test?

Your healthcare provider will ask health-related questions to ensure the procedure is safe for you. They’ll ask about your:

• Medications. This includes prescription and over-the-counter medications, herbs, vitamins and supplements.
• Medical history. This includes whether you have a history of bleeding disorders that cause you to bleed more than usual or an allergy to anesthesia or latex. They’ll also need to know whether you are or might be pregnant.

They’ll advise you on:

• What (if any) medicines you should stop taking leading up to the procedure.
• If you’ll need to fast (stop eating and drinking) at some point before the procedure.
• If you’ll need someone to drive you home and care for you. Depending on the procedure, it may not be safe to drive or be alone for the first 24 hours. Still, even if there aren’t any driving restrictions, it’s a good idea to have someone leave the hospital with you for moral support.

Your provider will also walk you through what to expect during your appointment. Don’t hesitate to ask questions during this part of the process.

What happens during a lymph node biopsy?

You’ll lie on an exam table. Regardless of the procedure type, your provider will give you anesthesia so you don’t feel any pain. If the lymph nodes are closer to your skin, you may only need local anesthesia to numb the area. For lymph nodes deeper inside your body, you may need general anesthesia to put you to sleep.

Once you’re asleep or the area’s completely numb, your provider will:

1. Locate the lymph node to be biopsied. Your provider may use an ultrasound, computed tomography (CT) scan or mammogram to find the exact spot. They may inject a special dye or tracer that drains into your lymph nodes so they show up more clearly.
2. Remove all or part of your lymph nodes. They’ll take care to disturb as little tissue as possible to prevent or minimize scarring.
3. Suture and bandage the area. You may get absorbable stitches, or you may need to come back so your provider can remove them.

How painful is a lymph node biopsy?

You may feel a quick prick and a sting when your healthcare provider injects the anesthesia, but you won’t feel any pain during the procedure. You may experience some discomfort afterward, but over-the-counter pain medications can provide relief until you’ve healed.

Your provider can advise you on which pain medicines you should take.

How long does a lymph node biopsy take?

A lymph node biopsy may take as little as 10 to 30 minutes for a simple needle biopsy and up to 45 minutes for an open biopsy. Much depends on how easily accessible your lymph nodes are.

What happens after a lymph node biopsy?

A lymph node biopsy is usually an outpatient procedure. This means you get to go home that same day.

Before you leave, your provider will check your vital signs (like your temperature and pulse) and make sure you’re safe to go home. They’ll advise you on monitoring the biopsy site and caring for it (and yourself).

They’ll provide instructions on:

• What normal healing looks like. For example, it’s normal to have slight bleeding, swelling, bruising and discomfort the first few days after a lymph node biopsy. It’s not normal to have worsening bleeding, pain or signs of an infection, like redness at the biopsy site.
• How to clean and care for your wound. You may need to avoid baths, hot tubs and even showers for a while to reduce the risk of infection.
• How to care for yourself. They’ll tell you when to resume medications and how to adjust your activity levels so you’re not straining your body during recovery. They may advise you to avoid lifting objects over a certain weight.

Before leaving, make sure you’re clear on the next steps. This includes knowing when to contact your provider if the wound isn’t healing as it should.

What are the risks of a lymph node biopsy?

A lymph node biopsy is a safe procedure. Still, no procedure is entirely without risk. Rare complications include:

• Infection. Although it’s uncommon, your healthcare provider may need to prescribe antibiotics to heal an infection.
• Worsening bleeding at the biopsy site. Your risk of bleeding varies depending on the procedure type and how many lymph nodes your provider removes. They can advise you on how much bleeding to expect.
• Numbness at the biopsy site. This can happen if a nerve is injured during your biopsy. The numbness usually goes away within a month or two.
• Swelling near the biopsy area (lymphedema). This can happen when there’s a problem with lymph fluid drainage after lymph node removal. As a biopsy only removes a few lymph nodes, this rarely happens.
• Axillary web syndrome (cording). You may notice cord-like structures underneath the skin of your inner arm after having lymph nodes removed from your armpit. Cording is extremely rare after a biopsy. And they usually disappear in time.

What type of results do you get, and what do the results mean?

Lymph node biopsy results show whether you’re positive for a certain disease (you have it) or negative (you don’t).

For example, a positive result may mean you have cancer cells in your lymph nodes. Your provider may do more tests to see if the cancer started in your lymph nodes or spread there from another part of your body.

Your provider will advise you on the next steps based on your results.

When should I know the results?

You may get results as soon as that same day or it may take a few weeks.

Same-day results are common in lymph node biopsies to test for cancer. After the biopsy, your healthcare provider may ask you to wait while they test the sample. If your results are positive, your healthcare provider can remove more lymph nodes that same day to check the extent of cancer spread. That way, you don’t have to schedule a follow-up visit.

Ask your provider about when to expect results and how you’ll receive them. Some providers prefer to call. Others post results online via a confidential patient portal.

When should I call my healthcare provider?

Call your provider if you notice signs of infection, including:

• Fever and chills.
• Swelling, warmth, redness or abnormal drainage at the biopsy site.

Most people heal without issue, but always contact your provider if you’re unsure.