Why perform a lymph node biopsy?

A lymph node biopsy is performed to diagnose the cause of persistent lymph node enlargement. It is common in children to have lymph nodes enlarge during viral infections, or to have a group of nodes enlarge and become tender if a skin infection is nearby. 

If lymph node enlargement does not respond to antibiotics, and particularly if the enlargement is painless without overlying skin inflammation, then removal of a sample node or part of the node is done so that microscopic examination and cultures can be done.

If a lymph node becomes infected and the infected node becomes abscessed, then surgical drainage of the lymph node may be required (this is different from a biopsy). Infection is the most common reason for lymph node enlargement, but malignancies both primary (lymphoma) and metastatic (spread from tumors in other organs) do occur in lymph nodes in children.

How is lymph node biopsy done?

Under general anesthesia, an incision is made over the enlarged lymph node, and the node is dissected out from its surroundings with care to tie off or cauterize vessels and lymphatic channels attached to it. The lymph node is then sent to the lab for testing. The incision is then closed in layers with absorbable sutures and local anesthetic is injected around the incision to help control postoperative pain. 

If a lymph node abscess is drained surgically, a sample of the pus in the abscess is sent to the lab to be cultured, and the abscess cavity is filled with packing gauze. The packing is then removed and the cavity loosely repacked daily till the cavity heals from inside out.

What are the effects of removing a lymph node?

The body has hundreds of lymph nodes, and removing one has no adverse effect on the body's immune defenses. Sometimes lymphatic fluid will fill up the hole left after a lymph node is removed, requiring removal with a needle and syringe. That is usually a very short term problem.

What is recovery like after a lymph node biopsy?

Most lymph node biopsies are outpatient procedures.

Postoperative pain is easily handled with prescription medication or over the counter pain medications, and activity restriction is short. Some patients will be instructed to take antibiotics. If a lymph node abscess is drained, arrangements will be made for daily wound packing changes, in the office or at home. That is typically necessary for about a week after the abscess is drained.