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How can you tell when a lymph node should be biopsied?
Aug 25, 2002

Several months back I noticed an axillary lymph node that is approximately 2.5 cm in diameter. My physician palpated it, but said not to worry. It is very movable, smooth, pretty firm, and non-tender. I have no systemic symptoms, etc. He felt that since it has been there 3 months (that I know of) and has not increased in size, there is no need to biopsy it. He said it is probably hyperplastic, but within normal limits. Of course I am concerned of lymphomas, etc. Do you agree with his assessment, or would you recommend further investigation? Thank you for your help

Response from Dr. Dezube

I am assuming that your are HIV positive, though your note does not specifically say so. Lymph nodes in HIV-infected patients are very common. Most commonly they are enlarged (hyperplastic) as they try to fight off the HIV infection. Unfortunately lymph nodes can also harbor cancer and infections.

When should they be biopsied? There are no hard and fast rules. I get more concerned if you have systemic symptoms (fever, chills, night sweats, weight loss); if one lymph node is way out of proportion to the other nodes; or if the lymph node continues to grow. Sometimes it's necessary to biopsy a lymph node just for peace of mind. You do not indicate in your note what sex you are. If you are a women, then an axillary (arm pit) node is more worrisome since breast cancer can cause enlarged lymph nodes in that area. One other point I want to make is that armpit nodes and groin pit nodes are very, very common. This is because cuts and scrapes on the arms and legs, respectively will lead to lymph nodes in these areas. Arm pit nodes are very common in cat lovers. In your case, if you are losing sleep over this lymph node and if it is not shrinking, then it may indeed pay to have it biopsied. We often say, "When in doubt, take it out".


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