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What do I do when my doctor won't biopsy my lymph nodes?
Apr 14, 2002

Dear Dr Dezube, I know the chances of this query will not be posted as chances are you will classify it as a worried well question. However, I will still proceed, as I desperately need you professional view. 7 months after a very high risk exposure I gathered enough courage to go for a blood test. I have experienced all the myriad acute viral symptoms within 4-6 weeks after the exposure. Till now I still have swollen nodes in several parts of my body (head, neck and groin) and this was verified by the Dr whom I have consulted. The nodes have been around for 6 months now. With Blessing from God, I got the result 2weeks ago and its NEGATIVE from the Dr but the lab result slip wasn't shown to me as the result was obtained through telephone. The Dr mentioned that the result SHOULD be accurate and I shouldn't be concern. I tried asking for a biopsy for the nodes but the Dr declined and mentioned that no one will perform a biopsy on nodes that are less than 1cm. (for your info, my nodes size varies from 0.5-1cm). He asked me not to worry and also assured me from the CBC/sedimentation result that I do not have any chronic infection nor cancer. From your professional view: 1. Should I forget about the whole incident and carry on with my life? 2. Get other specialists to biopsy the nodes (but first I need to know whether his statement is true as in 'no one will biopsy nodes that are 0.5cm in size). 3. Get another test done in other medical center.

Thanking you in advance

Response from Dr. Dezube

Although this may be a worried-well question as you indicate, this query does raise an important point-- what do you do when you want a procedure done (lymph node biopsy) and your health care provider doesn't want to perform it. You suggest several approaches, all of which are quite reasonable.

If your provider feels that a lymph node biopsy is not necessary, then you can probably "watch and wait" for a few weeks to a month. Maybe the lymph node indeed will shrink spontaneously. This often happens as infections (e.g. respiratory infections) come and go. Lymph nodes are more worrisome if they grow in size, if they are associated with systemic symptoms (e.g. fever, chills, night sweats, weight loss), if one lymph node is way out of proportion to the other nodes. Occasionally I have a patient who is going crazy over a lymph node despite my best reassurances. In such cases, which fortunately are quite rare, I do indeed end up getting these lymph nodes biopsied. For some patients, a negative biopsy is the only way to reassure them.

You ask about lymph node size. There is no single size such that below that size you are always safe, and above that size the lymph node is always worrisome. That said, a 0.5 cm node is quite small. The vast majority of such lymph nodes are not worrisome, but again, there is no guarantee.

You also suggest getting a second opinion. This is certainly reasonable in certain cases. Many insurance companies will pay for a second opinion. See how you feel in a few weeks and at that point either reapproach your health provider or approach a new health provider for a second opinion. One last thing, if you do choose a second opinion, it is often best to get it from a health care provider who does not work with your own doctor. You'll get a fresher look at the situation that way.


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