In lymph node biopsy, samples of lymph node tissue are taken from one or more locations; the specimens are sent to a laboratory for microscopic examination. The following techniques may be used:

Fine needle biopsy, which is done with local anesthesia, uses a long, thin needle to withdraw (aspirate) a specimen.

Excisional biopsy is a surgical procedure performed to completely excise one or a group of lymph nodes through a small incision. This is the method of choice when lymphatic cancer (lymphoma) is suspected. It is usually done with local anesthesia, but may require general anesthesia and hospitalization (for example, to obtain deeper nodes).

Sentinel lymph node (SLN) biopsy is a new technique that is increasingly used in cancer patients. Cancer cells can use the lymphatic system to spread (metastasize) throughout the body. Until lymph node biopsy, it was common to remove all lymph nodes nearest to a malignant tumor along with the tumor itself. But the so-called sentinel lymph node is the first one to receive lymphatic fluid draining from a cancer site; examining this node alone therefore indicates whether cancer has spread. Thus, surgeons can predict whether cancer is likely to be found in the rest of the lymphatic system without removing all of the nearby nodes. If the sentinel node contains no cancer cells, the other lymph nodes are likely to be clear, and a complete lymph node dissection may be unnecessary. If the sentinel node tests positive for cancer, however, all nearby nodes must be removed.

Purpose of the Lymph Node Biopsy

  • To distinguish between benign or malignant (cancerous) lymph node tumors, and to help diagnose lymphatic cancers such as Hodgkin’s disease and non-Hodgkin’s lymphomas
  • To determine whether cancer cells have metastasized to the lymph nodes from a nearby tumor
  • To identify the cause of lymph node enlargement due to nonmalignant conditions, such as infection or rheumatoid arthritis

Who Performs It

A physician performs lymph node biopsy.

Special Concerns

  • This procedure may not be safe in people with bleeding disorders.
  • Because SLN biopsy may use a radioactive tracer, this procedure should not be done in women who are pregnant or breastfeeding.

Before the Lymph Node Biopsy

  • Tell your doctor if you are taking any medications or supplements, including those you buy over-the-counter and have used only occasionally. Some, including aspirin, ibuprophen and vitamin E, may up your risk of bleeding.
  • If general anesthesia is being used, do not eat anything after midnight on the day before the test. You may drink only clear liquids.
  • Depending on the biopsy site, you may be asked to disrobe and put on a hospital gown.

What You Experience

Fine needle biopsy:

  • The skin over the biopsy site is cleansed with an antiseptic solution, and a local anesthetic is injected to numb the area (this injection may cause brief discomfort).
  • You will be positioned differently according to the selected biopsy site.
  • A thin biopsy needle is inserted into the lymph node, and a specimen is obtained. The tissue is sent to a laboratory for analysis.
  • The needle is withdrawn. Pressure is placed on the biopsy site until bleeding has stopped, and a small bandage is applied.
  • The procedure takes less than 15 minutes.

Excisional biopsy:

  • The skin over the biopsy site is cleansed with an antiseptic solution, and a local anesthetic is injected to numb the area.
  • You will be positioned differently according to the selected biopsy site.
  • Once the local anesthetic has taken effect, the doctor or surgeon will make a small incision in the skin over the node.
  • The selected node or cluster of nodes is removed and sent to a laboratory for analysis.
  • The incision is sutured closed, and a sterile dressing is applied.
  • Alternatively, this procedure is done while you are in an operating room under general anesthesia.
  • The procedure takes 15 to 30 minutes.

SLN biopsy:

  • The skin over the site of your primary tumor is cleansed with an antiseptic solution, and a local anesthetic is injected to numb the area (this injection may cause brief discomfort).
  • To determine which node is the sentinel, a radioactive tracer, a blue dye, or a combination of the two is injected into the tumor.
  • When the tracer or dye enters the lymph duct system, it flows from the tumor and drains into the nearest, or sentinel, node.
  • Once it is located, the surgeon will make a small incision and remove the entire sentinel node. The tissue is sent to a laboratory for analysis.
  • The incision is sutured closed and a bandage is applied.
  • The procedure takes 60 to 90 minutes.

Risks and Complications

Fine needle biopsy:

  • Rarely, bleeding or infection may occur.

Excisional biopsy:

  • A possible complication is lymphedema, a buildup of lymph fluid that causes uncomfortable, chronic swelling and stiffness around the biopsy site.
  • Rarely, bleeding or infection may occur.
  • If general anesthesia is used, the procedure carries the associated risks.

SLN biopsy:

  • This procedure is less invasive and initially produces less pain and discomfort than excisional biopsy. However, lymphedema, bleeding, and infection may still occur.
  • Delayed wound healing, bleeding from the wound, infectrion and other complications are more likely in patients with diabetes, obesity, heart disease or that smoke.
  • Allergy to blue dye is rare (less than 1%) but results in anaphylaxis, which is potentially serious.
  • The blue dye may result in a longstanding or permanent tattoo at the injection site.
  • The node biopsy, like more extensive surgery of lymph nodes, may result in lymphoedema; compression stockings may be recommended after biopsy of the groin nodes.
  • Nerve injuries are uncommon but can result in numbness or tingling. Cellulitis may also occur, although this is less likely than with full lymph node clearance.
  • The test may be a false negative i.e. the sentinel node is reported to be normal but in fact cancer has already spread (about 3% of cases). In that case, the lymph nodes may need to be cut out later on.
  • Sometimes, metastases may arise in distant sites of the body without involving the lymph nodes at all.

After the Lymph Node Biopsy

  • If you received general anesthesia, you must remain in the hospital until you recover from its effects. Otherwise, you may return home and resume your normal activities.
  • The biopsy site may remain sore for about 2 to 3 days. You may be given pain-relieving medication to allay any discomfort.
  • If you experience bleeding, tenderness, or redness around the biopsy site, call your doctor.

Results

  • Tissue specimens are sent to a pathology laboratory and inspected under a microscope for atypical cells.
  • If the biopsy reveals cancerous cells, your doctor will recommend appropriate medical or surgical treatment based on the findings. For example, after a positive SLN biopsy, surgery will be performed to completely excise the nodal cluster. More tests, such as a chest CT scan and a bone scan, may also be performed to determine if the cancer has spread. Hodgkin‘s and non-Hodgkin‘s lymphomas are typically treated with radiation therapy or chemotherapy.
  • If findings are unclear, additional tests, such as a biopsy of deeper lymph nodes taken during mediastinoscopy, may be required.
  • If no cancer is present, periodic testing may be recommended.

Source:

The Johns Hopkins Consumer Guide to Medical Tests

Simeon Margolis, M.D., Ph.D., Medical Editor

Updated by Remedy Health Media

Publication Review By: the Editorial Staff at Healthcommunities.com

Published: 12 Jan 2012

Last Modified: 04 Nov 2014