What is a lymph node biopsy?
A lymph node biopsy is a procedure done to obtain a tissue sample from an enlarged lymph node. A lymph node sample can be obtained by a fine needle aspirate, a surgical lymph node biopsy, or other techniques. Your doctor will talk with you about the type of biopsy you will need.

Why is it ordered?
Lymph nodes in healthy people are usually difficult to feel. However, nodes in the neck, armpit, or groin can become enlarged and tender. Swollen lymph nodes may indicate an infection, but can also be a symptom of cancer, a medication reaction, or conditions that cause inflammation.

The biopsy is done to take tissue to look at under the microscope to diagnose the problem causing the enlarged lymph nodes.

What should my health care professional know before I have this test/procedure done?

• Tell your doctor or nurse if you have an allergy to Betadine, iodine, or shellfish
• Tell your doctor or nurse if you have an allergy to local anesthetics
• Tell your doctor if you are taking any medicine (prescription or over-the-counter) or herbal or nutritional supplements. This includes common medicines and vitamins such as BC powder, aspirin, ibuprophen and vitamin E. These, and other medicines and herbs, may increase your risk of bleeding.
• Tell your doctor if you have any bleeding problems

Where is this done?

• Fine needle aspirate: This can be done in your hospital room or in the exam room in the clinic. This procedure is usually done by a surgeon or pathologist.
• Surgical lymph node biopsy: This procedure is done in an operating room, often in the ambulatory surgery center. This procedure is done by a surgeon.

Do I need to have someone drive me home afterward?

• Fine needle aspirate - No
• Surgical lymph node biopsy – Yes, you will need to have someone drive you home after this procedure

Do I need to do anything to get ready for this test?

• Fine needle aspirate: The lymph node fine needle aspirate test does not require any special preparation. You will not need to disrobe completely but may change into a gown or wear loose clothing that you can easily move to expose the area.
• Surgical lymph node biopsy: The surgeon will tell you if you need to do anything to get ready for this test, depending on the location of the biopsy and the anesthesia to be used. You will need to stop taking all medicines that can prolong bleeding, including Coumadin®, aspirin, BC powder®, and ibuprophen.

What happens during the procedure?

Fine needle aspirate:

• A doctor from the pathology department will come to your room. This doctor will explain the procedure and obtain your consent.
• The area will be cleaned with alcohol and Betadine®. This will feel cool and the Betadine® will temporarily color your skin brown. You may want to remove clothing that could be stained by the Betadine®.
• Lidocaine is injected into the area to numb the skin.
• A special needle is inserted into the lymph node and tissue is withdrawn into a syringe.
• A bandage is placed over the area.

Surgical lymph node biopsy:

• If your doctor feels that surgical removal of the entire lymph node or multiple lymph nodes is best for you, you will be referred to a surgeon.
• The surgeon will discuss the recommended procedure, including the risks, benefits, and any special preparations. A date and time for the procedure will be arranged. The surgeon will also discuss the anesthesia used for the procedure and pain management after the procedure.

Is this test/procedure painful?

• Fine needle aspirate: This test is about as painful as having blood drawn from your arm.
• Surgical lymph node biopsy: The discomfort associated with surgical lymph node biopsy will depend on the location of the surgery and the amount of tissue removed.

How long does it take?

• Fine needle aspirate: Five to 10 minutes
• Surgical lymph node biopsy: The actual biopsy takes about 20 minutes but the whole set up takes about an hour.

What happens after the procedure?

• Fine needle aspirate: The pathologist will examine the tissue under a microscope. While this is being done, you may be asked to wait in the exam room or back in the waiting room. Your doctor will have preliminary results in about 30 minutes. The final results will take up to 48 hours.
• Surgical lymph node biopsy: The biopsy results are usually ready within two to three business days. If special stains are being done, that may take additional time.

What are the risks with this procedure?
As with any procedure, there are small risks of bleeding and infection. These may be increased at times when you are more susceptible to bleeding or infection due to your disease or treatment. Precautions are taken to protect you from those risks as much as possible.

How will I get the results of this test?
Fine needle aspirate: When the pathologist has finished examining the tissue, you and your family will be called back to the exam room to discuss the preliminary results with your doctor.

Surgical lymph node biopsy: It may be several days before the results of a surgical lymph node biopsy are available. Your doctor will make an appointment with you to discuss the results or may call and discuss the results with you on the phone. Before you leave after having the biopsy done, you will have a plan in place for finding out the results.

Call your doctor if any of these things happen to you.
Call your doctor or nurse if you notice:

• Bleeding – apply pressure and contact your doctor or nurse right away
• Increased bruising after the first day
• Swelling
• Signs of infection such as fever, redness, drainage from the site, or increased tenderness

This article is intended as a resource for patients receiving their cancer care at Duke University Hospital or Duke Clinic. It is not intended to substitute for medical advice from your healthcare team. If your doctor’s instructions differ from the information in this article, please talk with your doctor before making any changes.

Source: Duke Cancer Patient Education Program; approved: Duke PEC, 12/03