Lymph node Removal

Swollen or affected lymph nodes may sometimes need to be removed for examination. This is called lymph node biopsy.

Lymph node biopsy

A biopsy involves removal of whole or part of the lymph node to look under the microscope for signs of infection, or cancer.

Lymph nodes are filters located at intervals between the lymph channels. They function as part of the immune system and harbour the lymphocytes that act against the infections or foreign bodies.

Normally they are hard to feel. However when affected by an infection or cancer they may get bigger at the neck, back of the head, under the jaws and chin, behind the ears, groin or arm pits.

Biopsy techniques

For a lymph node biopsy there may be several techniques the doctor may choose from. These include (1-4) –

  • Fine-needle aspiration – a thin needle is inserted into the lymph node and a small sample tissue is taken out in a syringe.
  • Core needle biopsy – A hollow needle with a special tip is inserted into the lymph node and a sample of tissue the size of a grain of rice is removed for examination
  • Open biopsy or complete lymph node removal – For this procedure the site is cleaned with an antiseptic and a sterile surgical drape is placed over it.

    The area is numbed using a local anesthetic injection. A small cut is made over the skin. The skin is then separated carefully from the underlying nodes. The surrounding tissue is carefully dissected away from the node. The surrounding nerves and blood vessels, especially in areas around the neck are avoided.

    A needle with a suture is passed through the center of the node and traction is applied to it. The node is cut off gently. A single or more lymph nodes may be removed. If a single node is removed the procedure is to examine it under the microscope.

    If more than one lymph node is taken, the biopsy is called a lymph node dissection. A lymph node dissection may be performed under wider anesthesia using regional anesthetic blocks or even under general anesthesia.

    An open biopsy usually takes from 30 to 60 minutes. However if there is a lymph node dissection to remove cancer, the surgery may take longer. After the surgery the skin ends are sutured or stapled and the site is dressed.

When is lymph node removal required?

An open biopsy is needed in cases of (1-4) –

  • Cancers – Lymphomas are cancers of the lymphatic system where there may be associated fever, fatigue, weight loss and excessive sweating at night.
  • Staging of cancers. Many cancers, like breast cancer, spread via the lymphatic channels.

    Examination of spread to the nearest lymph nodes can help the physician understand the extent of spread. This helps in staging the disease. For example, if there is extensive spread to the lymph nodes, the cancer may be of advanced stages.

  • Cancer removal – sometimes lymph nodes that have been affected are removed completely to remove the cancer and prevent its further spread.
  • A sentinel lymph node biopsy – This is usually the first lymph node to which cancer cells are most likely to spread from a primary tumor. It acts as a guard or sentinel to the affected organ.

    A sentinel lymph node biopsy is used to determine the extent, or stage, of cancer in the body.

    For sentinel lymph node biopsy of breast cancer an incision is made under the crease of the arm of the affected side. Usually it is done under general anesthesia along with removal of the tumor from the breast as well.

Complications of lymph node removal

Complications of lymph node removal include bleeding, pain, risk of infections of the operative site, injury of surrounding structures around the node like blood vessels, and nerves.

Sometimes mishandling of a cancerous node may lead to spread of tumor cells in the area of the biopsy or spread of infection from the node. (4)

Further Reading

Last Updated: Jun 5, 2019

Dr. Ananya Mandal

Written by

Dr. Ananya Mandal

Dr. Ananya Mandal is a doctor by profession, lecturer by vocation and a medical writer by passion. She specialized in Clinical Pharmacology after her bachelor's (MBBS). For her, health communication is not just writing complicated reviews for professionals but making medical knowledge understandable and available to the general public as well.


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  1. Corey Hayes Corey Hayes United States says:

    Mine started with extreme acute onset of a highgrade fever upwards of 103. I would get then more and more as the year went on till it was every week.Then one morning I woke up with the right dise of my neck swelled up putting pressure on the back of my skull.Went to a specialist ENT and he took 2 large drain neeedles of fluid from my neck. Then he took a biopsy of the tissue.The biopsy was benign infected lymph nodes and a brachial cleft cyst.The surgery took 3 hours because of the amount of infected tissue that had to be removed.And I woke up with a incision from my jaw to collarbone.The worst part of recovery was they had to cut muscle from my neck to shoulder.It took me almost a year to get full strength back in my right arm.They also put a drain tube in my neck which I had for 7 to 10 days after surgery.

  2. Kay Creswell Ex Stubbs Kay Creswell Ex Stubbs United States says:

    I had a sore throat, went to the 'little clinic', Doc said my lymph nodes in my neck were swollen, (that was back in July).  She told me to get a full blood work up.  I just did - in October.  My GYN Doc felt of my neck and could feel some swelling.  She did a full blood work up - everything came back normal.  Even the chest x-ray she sent me to have done.   I had a dental apt this week and had my dentist feel my throat...I was sensitive to his pressure, but he said it wouldn't hurt to do further testing especially if it hurt for him to mash on the right side of my chin.  Guess I'll call my PCP.

    • Deepika Kale Deepika Kale Czech Republic says:

      Hi can you please tell me finally what was the disease? I have some what similar  symptoms. Doctors did my X-ray it was clean no infection. I showed it ENT specialist no infection of ears. My ultrasound showed my organs are fine. Doctors thought I might have TB. then also did all the test related to TB,it seems negative. I don't know what is wrong with me.  If it was undetermined   , did the swelling gone on its own??? or they gave you medicines. Thanks

  3. fatima alzahraa fatima alzahraa Algeria says:

    To Kay Creswell Ex Stubbs  i'm going through the same condition as yours and i'm really afraid of the surgery..does it leave a remarkable  scar!! please answer me!!

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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