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Lymph Nodes FΝΑ

Our goal is  to provide accurate laboratory testing, with a reasonable turnaround time, in a cost-effective manner. 

Enlarged lymph nodes are easily accessible for fine needle aspiration and hence fine needle aspiration cytology (FNAC) is a very simple and important diagnostic tool for lymph node lesions.

Malignancies in lymph nodes in our country are predominantly metastatic in nature with an incidence varying from 65.7% to 80.4% and lymphomas range from 2% to 15.3% among lymph nodes aspirated from all sites. Although histopathological examination is considered to be gold standard in diagnosis especially in lymphomas, FNAC maybe the only tool for diagnosis and further management of the patients in some cases of metastatic malignancy.

A lymph node biopsy can take place at a hospital, in your doctor’s office, or in other medical facilities. It’s typically an outpatient procedure, which means you don’t have to stay overnight at the facility.

With a lymph node biopsy, your doctor may remove the entire lymph node, or take a tissue sample from the swollen lymph node. Once the doctor removes the node or sample, they send it to a pathologist in a lab, who examines the lymph node or tissue sample under a microscope.

Fine needle aspiration cytology (FNAC) has become popular as a valuable tool in preoperative assessment of breast masses, and it shows high accuracy, sensitivity, and specificity. It has gained popularity due to its fast and easy approach, being inexpensive, and can be performed with little complications. To differentiate benign from malignant lesions is one of the major goals of FNAC. In the evaluation of lymph nodes, the time honored triple assessment combines clinical, radiological, and pathological information, and FNAC, together with core needle biopsy, is the initial pathological investigative methods of choice. Much confidence has been placed on this approach for it can obviate standard excisional biopsy when all three components of the triple test are conclusively negative or positive 

A lymph node fine needle aspiration (FNA) is a quick and simple procedure to perform, which removes some fluid or cells from a lymph node  with a fine needle similar to a blood sample needle. The sample of fluid or cells is smeared on a glass slide and sent to a pathology laboratory to be examined by a specialist doctor (a cytologist) under a microscope. An FNA is performed to help determine the nature or diagnosis of the lesion and to plan treatment if necessary.

Health Tips 

What is a lymph node biopsy?

A lymph node biopsy is a test that checks for disease in your lymph nodes. Lymph nodes are small, oval-shaped organs located in different parts of your body. They’re found close to internal organs such as your stomach, intestines, and lungs, and are most commonly noted in the armpits, the groin, and the neck.

Lymph nodes are part of your immune system, and they help your body recognize and fight off infections. A lymph node may swell in response to an infection somewhere in your body. Swollen lymph nodes can appear as a lump beneath your skin.

Your doctor may find swollen or enlarged lymph nodes during a routine examination. Swollen lymph nodes that result from minor infections or insect bites typically don’t require medical care. However, to rule out other problems, your doctor may monitor and check your swollen lymph nodes.

If your lymph nodes remain swollen or grow even larger, your doctor may order a lymph node biopsy. This test will help your doctor look for signs of a chronic infection, an immune disorder, or cancer.

What are the types of lymph node biopsy?

A lymph node biopsy can take place at a hospital, in your doctor’s office, or in other medical facilities. It’s typically an outpatient procedure, which means you don’t have to stay overnight at the facility.

With a lymph node biopsy, your doctor may remove the entire lymph node, or take a tissue sample from the swollen lymph node. Once the doctor removes the node or sample, they send it to a pathologist in a lab, who examines the lymph node or tissue sample under a microscope.

There are three ways to perform a lymph node biopsy.

Needle biopsy
A needle biopsy removes a small sample of cells from your lymph node.

This procedure takes about 10 to 15 minutes. While you’re lying on an examination table, your doctor will clean the biopsy site and apply medication to numb the area. Your doctor will insert a fine needle into your lymph node and remove a sample of cells. They’ll then remove the needle and put a bandage on the site.

Open biopsy
An open biopsy removes either a portion of your lymph node or the entire lymph node.

Your doctor can perform this procedure with local anesthesia, using a numbing medication applied to the biopsy site. You can also request general anesthesia that will make you sleep through the procedure.

The entire procedure takes between 30 and 45 minutes. Your doctor will:

make a small cut
remove the lymph node or portion of the lymph node
stitch the biopsy site closed
apply a bandage
Pain is generally mild after an open biopsy, and your doctor may suggest over-the-counter pain medications. It takes about 10 to 14 days for the incision to heal. You should avoid strenuous activity and exercise while your incision heals.

Sentinel biopsy
If you have cancer, your doctor may perform a sentinel biopsy to determine where your cancer is likely to spread.

With this procedure, your doctor will inject a blue dye, which is also called a tracer, into your body near the cancer site. The dye travels to the sentinel nodes, which are the first few lymph nodes into which a tumor drains.

Your doctor will then remove this lymph node and send it to a lab to check it for cancer cells. Your doctor will make treatment recommendations based on the lab results.

What are the risks associated with a lymph node biopsy?

There are risks involved with any type of surgical procedure. Most of the risks of the three types of lymph node biopsy are similar. Notable risks include:

tenderness around the biopsy site
infection
bleeding
numbness caused by accidental nerve damage
Infection is relatively rare and can be treated with antibiotics. Numbness can occur if the biopsy is done near nerves. Any numbness typically disappears within a couple of months.

If you have your entire lymph node removed — this is called a lymphadenectomy — you could have other side effects. One possible effect is a condition called lymphedema. This can cause swelling in the affected area. Your doctor can tell you more.

How do I prepare for a lymph node biopsy?

Before scheduling your lymph node biopsy, tell your doctor about any medications that you’re taking. This includes non-prescription medications, such as aspirin, other blood thinners, and supplements. Also tell your doctor if you’re pregnant, and tell them about any medication allergies, latex allergies, or bleeding disorders you have.

Stop taking prescription and non-prescription blood thinners at least five days before your scheduled procedure. Also, don’t eat or drink for several hours before your scheduled biopsy. Your doctor will give you more specific instructions on how to prepare.

What is the recovery process after a lymph node biopsy?

Pain and tenderness can last for a few days after a biopsy. Once you get home, keep the biopsy site clean and dry at all times. Your doctor may ask you to avoid showers or baths for a couple of days after the surgery.

You should also pay close attention to the biopsy site and your physical condition after the procedure. Call your doctor if you show signs of an infection or complications, including:

fever
chills
swelling
intense pain
bleeding or discharge from the biopsy site

What do the results mean?

On average, test results are ready within 5 to 7 days. Your doctor may call you with the results, or you may need to schedule a follow-up office visit.

Possible results
With a lymph node biopsy, you doctor is likely looking for signs of an infection, an immune disorder, or cancer. Your biopsy results could show that you have none of these conditions, or it could indicate that you may have one of them.

If cancer cells are detected in the biopsy, it could be a sign of one of the following conditions:

Hodgkin’s lymphoma
non-Hodgkin’s lymphoma
breast cancer
lung cancer
oral cancer
leukemia
If the biopsy rules out cancer, your doctor may order additional tests to determine the cause of your enlarged lymph nodes.

Abnormal results of a lymph node biopsy could also mean you have an infection or immune system disorder, such as:

HIV or another sexually transmitted disease, such as syphilis or chlamydia
rheumatoid arthritis
tuberculosis
cat scratch fever
mononucleosis
an infected tooth
a skin infection
systemic lupus erythematosus (SLE), or lupus

WHAT IS FNA?

Fine needle aspiration (FNA), also called fine needle biopsy, is a type of biopsy that can be used to diagnose many types of lumps (masses). FNA is used to obtain microscopic cells for analysis and can be used to diagnose various problems, including infection, inflammation, and cancer.

FNA Is Used for Diagnosis In:

• Thyroid Gland
• Neck lymph nodes
Neck cysts
Salivary glands (i.e. parotid gland, submandibular gland)
Any lump that can be felt
Lumps that are found on imaging tests (such as ultrasound) even if they can’t be felt

WHY IS FNA IMPORTANT?

A mass or lump may indicate a serious problem such as cancer*. While every lump is not cancer, many lumps do need FNA biopsy. Other factors that help your provider diagnose a lump are your symptoms such as ear pain, difficulty swallowing, weight loss; your personal history, such as age, sex, smoking and drinking habits, prior skin cancer, and your family history, such as parathyroid cancer.

* When found early, most cancers in the head and neck can be cured. Cure rates for these cancers are greatly improved if people seek medical advice as soon as possible. So play it safe. If you have a lump in your head and neck area, see your otolaryngologist right away.

HOW IS FNA DONE?

The doctor inserts a small needle into the lump, draws out a tiny amount of tissue, and then examines the tissue under the microscope to make a diagnosis. If the lump is difficult to feel, an ultrasound device can be used to help direct the needle into the lump. Local anesthesia (numbing medicine) if often not necessary because the needle used for FNA is smaller the a needle used for a blood test from the arm (venipuncture). Although not painless, the discomfort from FNA is usually minimal. FNA is generally accurate and frequently prevents the patient from having an open, surgical biopsy, which is more painful and costly.

WHAT ARE THE COMPLICATIONS OF THE FNA PROCEDURE?

No medical procedure is without risks, but complications from FNA are uncommon. Bleeding is the most common complication, when it occurs, it is usually a small bruise. Bleeding is more common in patients who take aspirin, Advil®, or blood thinners, such as warfarin. Infection from FNA is rare. Sometimes the results of an FNA are inconclusive, in which case another FNA or a different type of biopsy procedure may needed. Because the needle is so tiny, spreading a cancer with an FNA biopsy is very rare.

What is a lymph node fine needle aspiration?

A lymph node fine needle aspiration (FNA) is a quick and simple procedure to perform, which removes some fluid or cells from a lymph node lesion with a fine needle similar to a blood sample needle. The sample of fluid or cells is smeared on a glass slide and sent to a pathology laboratory to be examined by a specialist doctor (a cytologist) under a microscope. An FNA is performed to help determine the nature or diagnosis of the lesion and to plan treatment if necessary.
If the lesion cannot be felt from the surface of the skin, the doctor may use guidance for the FNA by using ultrasound images or pictures (see ultrasound). This shows an image of the inside of your lymph node on a screen to allow the doctor to ensure the needle is going into the lesion.

How do I prepare for a lymph node FNA?

There is no need for special preparation before a Lymph node FNA. Lymph node FNA can be done immediately after you have had a medical examination and any imaging your doctor may have referred you for, such as a mammogram and/or ultrasound to find out the cause of the lesion.
Lymph node FNA can be uncomfortable and sometimes painful and you may wish to ask a friend or a relative to attend the appointment with you if you think you will need some support before or after the procedure.
Wear a comfortable two piece outfit, as you will need to have the upper body undressed for the Lymph node FNA

What happens during a lymph node FNA?

The doctor performing the lymph node FNA will decide whether it is best to use ultrasound or mammography images or pictures to locate the lesion and guide placement of the needle. If the doctor can feel the lesion it is said to be “palpable”, and these are sometimes sampled without using imaging to guide the needle.

Ultrasound guidance

The doctor will clean your lymph node with an antiseptic liquid and place the needle through the skin and into the lesion guided by the ultrasound images.
Local anaesthetic on the skin area where the needle is inserted is sometimes given. If the doctor does not provide anaesthetic you can ask about this before the needle is inserted.
When the needle is inserted into the lesion, the doctor will make several small (less than 1cm) forward and backward, gentle movements with the needle to collect cells or, if the lesion is a cyst, fluid may be collected. Two or three separate samples are usually taken in this way to ensure a good sample has been obtained.

How long does a lymph node FNA take?

Lymph node FNA is a quick test, which takes 10 to 20 seconds for each sample and this procedure may be repeated several times until the doctor is sure a good sample is collected. The examination and FNA procedure will generally take around 20 to 30 minutes for ultrasound guidance

What are the risks of a lymph node FNA?

The risks of a lymph node FNA are rare and minimal and can include:
• Minimal bleeding and bruising, especially for those on anticoagulation (warfarin, heparin), aspirin, or anti-platelet medication.
• Risk of infection is rare. Lymph node FNA is a clean and sterile procedure, which uses skin antiseptic and disposable one-use needles.
• If the lesion being biopsied is found to be cancer, there is a very small risk of displacement (“seeding” or implantation) of tumour cells along the tract or path of the needle as it is withdrawn from the lymph node. This is extremely rare.
• Lymph node FNA may not always provide a definitive diagnosis (or answer) about what the lesion in your lymph node is. In particular, it may not allow cancer to be definitely ruled out even if no cancer cells are found in the samples of material removed from your lymph node. The result of the FNA needs to be considered along with the results of other lymph node imaging and your doctor’s examination findings.

What are the benefits of a lymph node FNA?

Lymph node FNA is a quick and simple procedure to perform to investigate a lymph node lesion.
There are few complications in having the test and few cases where the test is not appropriate due to a pre-existing medical or physical condition. Lymph node FNA can be used when other needle biopsy procedures are not possible, for example, if you are using anticoagulant medication, have an allergy to anaesthetic

Who does the lymph node FNA?

Lymph node FNA should be done after careful medical examination and imaging tests to ensure the correct diagnosis is made. Lymph node FNA is done by specialist doctors experienced in lymph node needle biopsy procedures.

Where is a lymph node FNA done?

Lymph node FNA is an outpatient procedure. Image guided lymph node FNA will be performed in a public or private hospital, radiology practice, a public or private specialist lymph node clinic, at a Lymph nodeScreen assessment clinic, or a surgeon or doctors’ rooms equipped with ultrasound.

When can I expect the results of my lymph node FNA?

Tests of the fluid or tissue sample will need to be done in a laboratory to confirm the diagnosis and are usually available within one or two days. These results, together with the results of medical and imaging examinations, are considered and interpreted and a report written for your referring doctor. Usually, you can obtain the final results of the lymph node FNA from your own doctor within a week.