Lymph node biopsy is a test in which a

lymph node A lymph node, or lymph gland, is a kidney-shaped organ of the lymphatic system and the adaptive immune system. A large number of lymph nodes are linked throughout the body by the lymphatic vessels. They are major sites of lymphocytes that includ ...

or a piece of a lymph node is removed for examination under a

microscope A microscope () is a laboratory equipment, laboratory instrument used to examine objects that are too small to be seen by the naked eye. Microscopy is the science of investigating small objects and structures using a microscope. Microscopic ...

(see:

biopsy A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, an interventional radiologist, or an interventional cardiology, interventional cardiologist. The process involves the extraction of sampling (medicine), sample ...

). The

lymphatic system The lymphatic system, or lymphoid system, is an organ system in vertebrates that is part of the immune system and complementary to the circulatory system. It consists of a large network of lymphatic vessels, lymph nodes, lymphoid organs, lympha ...

is made up of several lymph nodes connected by

lymph vessel The lymphatic vessels (or lymph vessels or lymphatics) are thin-walled vessels (tubes), structured like blood vessels, that carry lymph. As part of the lymphatic system, lymph vessels are complementary to the cardiovascular system. Lymph vessel ...

s. The nodes produce white blood cells (

lymphocytes A lymphocyte is a type of white blood cell (leukocyte) in the immune system of most vertebrates. Lymphocytes include T cells (for cell-mediated and cytotoxic adaptive immunity), B cells (for humoral, antibody-driven adaptive immunity), and ...

) that fight

infection An infection is the invasion of tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmis ...

s. When an infection is present, the lymph nodes swell, produce more white blood cells, and attempt to trap the organisms that are causing the infection. The lymph nodes also try to trap

cancer Cancer is a group of diseases involving Cell growth#Disorders, abnormal cell growth with the potential to Invasion (cancer), invade or Metastasis, spread to other parts of the body. These contrast with benign tumors, which do not spread. Po ...

cells. Imaging studies include CXR, CT scans of Abdomen,chest, pelvis, neck and PET scans. CBC, ESR, serum ferritin, bone marrow aspiration.

Indications

The test is used to help determine the cause of lymph node enlargement (swollen glands or

lymphadenitis Lymphadenopathy or adenopathy is a disease of the lymph nodes, in which they are abnormal in size or consistency. Lymphadenopathy of an inflammatory type (the most common type) is lymphadenitis, producing swollen or enlarged lymph nodes. In cl ...

). It may also determine whether

tumor A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

s in the lymph node are

ous or noncancerous. Enlarged lymph nodes may be caused by a number of conditions, ranging from very mild

s to serious

malignancies Malignancy () is the tendency of a medical condition to become progressively worse; the term is most familiar as a characterization of cancer. A ''malignant'' tumor contrasts with a non-cancerous ''benign'' tumor in that a malignancy is not ...

Benign Malignancy () is the tendency of a medical condition to become progressively worse; the term is most familiar as a characterization of cancer. A ''malignant'' tumor contrasts with a non-cancerous benign tumor, ''benign'' tumor in that a malig ...

conditions can often be distinguished from cancerous and infectious processes by microscopic examination. The

pathologist Pathology is the study of disease. The word ''pathology'' also refers to the study of disease in general, incorporating a wide range of biology research fields and medical practices. However, when used in the context of modern medical treatme ...

may also perform additional tests on the lymph node tissue to assist in making a

diagnosis Diagnosis (: diagnoses) is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in a lot of different academic discipline, disciplines, with variations in the use of logic, analytics, and experience, to determine " ...

. Some of the conditions where abnormal values are obtained are: *

Hodgkin's lymphoma Hodgkin lymphoma (HL) is a type of lymphoma in which cancer originates from a specific type of white blood cell called lymphocytes, where multinucleated Reed–Sternberg cells (RS cells) are present in the lymph nodes. The condition was named a ...

Non-Hodgkin's lymphoma Non-Hodgkin lymphoma (NHL), also known as non-Hodgkin's lymphoma, is a group of blood cancers that includes all types of lymphomas except Hodgkin lymphomas. Symptoms include enlarged lymph nodes, fever, night sweats, weight loss, and tire ...

Sarcoidosis Sarcoidosis (; also known as Besnier–Boeck–Schaumann disease) is a disease involving abnormal collections of White blood cell, inflammatory cells that form lumps known as granulomata. The disease usually begins in the lungs, skin, or lymph n ...

tuberculous cervical lymphadenitis The disease mycobacterial cervical lymphadenitis, also known historically as scrofula and the king's evil, involves a lymphadenitis of the cervical (neck) lymph nodes associated with tuberculosis as well as nontuberculous (atypical) mycobacteria ...

(scrofula) Lymph node biopsies may be performed to evaluate the spread of cancer. See Lymphadenectomy#With sentinel node biopsy. However, Sentinel lymph node biopsy for evaluating early, thin

melanoma Melanoma is the most dangerous type of skin cancer; it develops from the melanin-producing cells known as melanocytes. It typically occurs in the skin, but may rarely occur in the mouth, intestines, or eye (uveal melanoma). In very rare case ...

has not been shown to improve survival, and for this reason, should not be performed., which cites * * * Patients with melanoma in situ, T1a melanoma or T1b melanoma ≤ 0.5mm have a low risk of cancer spreading to lymph nodes and high 5-year survival rates, so this kind of biopsy is unnecessary.

Procedure

The test is done in an

operating room Operation or Operations may refer to: Arts, entertainment and media * ''Operation'' (game), a battery-operated board game that challenges dexterity * Operation (music), a term used in musical set theory * ''Operations'' (magazine), Multi-Man ...

in a

hospital A hospital is a healthcare institution providing patient treatment with specialized Medical Science, health science and auxiliary healthcare staff and medical equipment. The best-known type of hospital is the general hospital, which typically ...

, or at an outpatient surgical facility. There are two ways the sample may be obtained: * Needle biopsy * Open ( excisional) biopsy

Needle biopsy

A needle biopsy involves inserting a needle into a node to obtain the sample. The patient lies on the examination table; the biopsy site is cleansed; and a

local anesthetic A local anesthetic (LA) is a medication that causes absence of all sensation (including pain) in a specific body part without loss of consciousness, providing local anesthesia, as opposed to a general anesthetic, which eliminates all sensati ...

is injected. The

needle is then inserted into the node. A sample is removed, pressure is applied to the site to stop the

bleeding Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethr ...

, and a bandage is applied.

Open biopsy

An open biopsy consists of surgically removing all or part of a node. The patient lies on the examination table and is given a

sedative A sedative or tranquilliser is a substance that induces sedation by reducing irritability or Psychomotor agitation, excitement. They are central nervous system (CNS) Depressant, depressants and interact with brain activity, causing its decelera ...

. The

skin Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other animal coverings, such as the arthropod exoskeleton, have different ...

over the biopsy site is cleansed, and a local anesthetic is injected (occasionally, a

general anesthetic General anaesthetics (or anesthetics) are often defined as compounds that induce a loss of consciousness in humans or loss of righting reflex in animals. Clinical definitions are also extended to include an induced coma that causes lack of aware ...

is given). A small incision is made, and the lymph node or part of the node is removed. The incision is then closed with stitches and

bandage A bandage is a piece of material used either to support a medical device such as a dressing or splint, or on its own to provide support for the movement of a part of the body. When used with a dressing, the dressing is applied directly on ...

d. The sample is then sent to

pathology Pathology is the study of disease. The word ''pathology'' also refers to the study of disease in general, incorporating a wide range of biology research fields and medical practices. However, when used in the context of modern medical treatme ...

. With this test there is a small chance of

. Additionally, there is a moderate risk of

nerve A nerve is an enclosed, cable-like bundle of nerve fibers (called axons). Nerves have historically been considered the basic units of the peripheral nervous system. A nerve provides a common pathway for the Electrochemistry, electrochemical nerv ...

injury, localized

paralysis Paralysis (: paralyses; also known as plegia) is a loss of Motor skill, motor function in one or more Skeletal muscle, muscles. Paralysis can also be accompanied by a loss of feeling (sensory loss) in the affected area if there is sensory d ...

, or

numbness Hypoesthesia or numbness is a common side effect of various medical conditions that manifests as a reduced sense of touch or sensation, or a partial loss of sensitivity to Sensory receptor, sensory stimuli. In everyday speech this is generally r ...

when the biopsy is performed on a lymph node close to

References

External links

Cancer Management Handbook: Lymph node biopsy
{{Lymphatic organ procedures Biopsy Lymphatic organ surgery