Lymph node biopsy guided by ultrasound

A lymph node biopsy is when a doctor checks and removes a small piece of tissue or sample of cells from one of your lymph nodes. The doctor sends this to the laboratory and a specialist doctor called a pathologist examines it under a microscope.

To check the lymph nodes, you have an ultrasound. Ultrasound scans use high frequency sound waves to create a picture of a part of the body.

If doctors find any abnormal areas, they can use the ultrasound to guide a needle and take a biopsy. 

You usually have this test as an outpatient in your hospital imaging department.

Depending on where in your body the lymph nodes are, your doctor may also use a CT scan to guide the biopsy needle. These are CT guided lymph node biopsies.

You usually have a lymph node biopsy under local anaesthetic . Occasionally, you may have it under general anaesthetic. This means that you are asleep and won’t feel anything.

What is a lymph node?

Lymph nodes are part of our lymphatic system. This is a network of thin tubes and nodes that run throughout the body and carry a fluid called lymph.

Lymph nodes filter the lymph fluid as it passes through them. They can trap bacteria, viruses and cancer cells. Lymph nodes are also called lymph glands.

We have lymph nodes almost everywhere in our body. They are usually small and can only be felt in certain areas such as:

• your neck

• under the arm (armpit)

• your groin

Why do I need a lymph node biopsy guided by ultrasound?

Lymph nodes can become enlarged (swollen) for different reasons. The most common reason is when you have an infection. For example, an infection in your ear or throat can make the lymph nodes in your neck swollen. Swollen lymph nodes caused by infections usually reduce size within 1 to 2 weeks.

Lymph nodes are also often the first place cancer cells spread to when they break away from the primary cancer . Your doctor might ask you to have a lymph node ultrasound and biopsy to:

• find out if a cancer has spread into your lymph nodes
• help diagnose cancer if you have a swollen lymph node

Swollen lymph nodes in your neck

Different types of cancer can spread into the lymph nodes in your neck. This includes:

• lung cancer

• head and neck cancers such as mouth and throat cancer

The diagram below shows the lymph nodes in your head and neck area.

Swollen lymph nodes in your armpit

Different types of cancer can spread into the lymph nodes in your armpit, but this is more common with breast cancer. You may also hear your doctor calling these axillary lymph nodes. This is because axilla is the medical term for armpit.

The diagram below shows the network of lymph nodes in your axilla and breast.

Swollen lymph nodes in your groin

The groin is the area at the top of your legs, between the hips. Different types of cancer can spread to the lymph nodes in your groin. This includes anal and penile cancer.

Preparing for the test

Check your appointment letter for instructions on how to prepare for this test. You should be able to eat and drink normally beforehand.

Take your medicines as normal unless you’re told otherwise. Let your doctor know if you take medicines to thin your blood such as warfarin. You might need to stop them for a few days before the test.

What happens before the test

On the day of the test, your doctor explains what will happen. They might ask you to sign a consent form. This is a good time to ask any questions you might have.

A nurse or other healthcare professional will ask you to change into a hospital gown. They then take you into the ultrasound room.

What happens during the lymph node ultrasound scan

Your nurse or doctor asks you to lie down on the scanner couch. Depending on where you are having the scan, your doctor may ask you to put your arms over your head.

A specialist doctor called a radiologist usually does the scan. They put a gel on the skin over the area where the lymph nodes are.

The ultrasound scanner has a microphone or probe that gives off sound waves. The sound waves bounce off the organs inside your body and are picked up by the microphone. The microphone links to a computer that turns the sound waves into a picture.

They then put the handheld ultrasound probe over the skin.

You might feel a little pressure when they move the probe. This shouldn’t hurt but tell your doctor if this is uncomfortable for you.

If your lymph nodes look normal, they will finish the scan. Or they might ask to take a biopsy if they see any changes on the ultrasound.

What happens during the lymph node biopsy

Before taking the biopsy, your doctor cleans the skin. They then use a local anaesthetic to numb the area where the abnormal lymph node is. This might sting a little.

When the area is numb, they put a thin needle attached to a syringe through your skin. They then draw back some cells and fluid into the syringe.

They might also take out some tissue using a special biopsy needle.

You might feel some pressure and it can sometimes feel uncomfortable. Do let your doctor know if it is painful. You may need more local anaesthetic.

Your doctor removes the needle once the sample is taken. They put pressure on the area where you had the biopsy for a few minutes after the test. This is to prevent bleeding and bruising.

After the test

Your doctor sends the fluid and tissue sample to the laboratory. A specialist doctor called a pathologist looks at the sample under a microscope. They can see if you have cancer in your lymph nodes.

You should be able to go home soon after the test. You have a small dressing over the area where they took the biopsy. Your doctor or nurse will tell you how to look after this for the next few days.

Possible risks

A lymph node biopsy is a safe procedure but your doctor or nurse will tell you who to contact if you have any problems afterwards.

As with any medical procedure, there are possible side effects or complications. Your doctor makes sure the benefits of having a lymph node biopsy outweigh these possible risks.

Everyone is different and the side effects can vary from person to person. You may not have all the effects mentioned. Side effects can include:

Pain

You may have some discomfort once the local anaesthetic has worn off. This usually settles within 1 to 2 days. Painkillers such as paracetamol can help.

Bleeding

You might see a small amount of blood on the dressing after the biopsy. Let your doctor or nurse know straight away if there is a lot of bleeding from your biopsy site.

Infection

Contact your GP or the hospital if you have a high temperature, feel unwell or if there is swelling at the biopsy site.

Getting your results

It takes 1 or 2 weeks to get the results. Your specialist will usually discuss them with you at your next clinic appointment.

Waiting for test results can be a worrying time. You might have contact details for a specialist nurse. You can get in touch with them for information and support if you need to. It may help to talk to a close friend or relative about how you feel. You may want them to go with you to get the results for support.