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Lymph node biopsy or not?
Jan 21, 2002

My GP recently referred me to a general surgeon to biopsy a lymph node at the back of my neck that has been consistently enlarged for several months (considerably bigger than pea size). The surgeon looked at it and said a biopsy wouldn't really tell us anything anyway, so he felt it was unnecessary and didn't do it. I haven't heard back from my GP yet on this. I am not on meds, my cd4 is around 380, VL 50,000. I have other swollen lymph nodes on occasion in groin and neck, but smaller (shotty) and transitory. Would you recommmend a biopsy on this one node, and if so why?

Response from Dr. Dezube

I will answer this briefly, but please also refer to the many other postings in my forum on abnormal nodes. Small lymph nodes are seen in almost every HIV-positive person at a given time. This is the body's attempt at fighting off the HIV. We worry about lymph nodes when they are in the setting of systemic symptoms (fever, chills, night sweats, weight loss), if one lymph node is way our of proportion to the other, if it's growing, if it's unusually large, and so on. It's hard for me to tell based on your query if your lymph node is anything out of the ordinary for an HIV'er. Most lymph nodes can be safely observed over the course of a few months or so if the person is in otherwise good health. A CD4 count of 380 is quite reassuring since with a relatively healthy CD4 count as this, the likelihood that you are harboring an infection in your lymph nodes is less. As you have already been evaluated by what I presume to be a qualified surgeon, then it may not be unreasonable to see what happens to the lymph node over a 1-2 month period. HOWEVER, if it's driving you crazy (i.e. high anxiety), then a biopsy may also be reasonable based on the adage "when in doubt, take it out". I obviously can't give you a definite "yes" or "no" to your question. Hopefully I gave you some guidelines upon which to base your decision. Let me know what you decide.


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