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Lymph node biopsy; my surgeon couldn't find it at the time of surgery
Sep 18, 2001

I've had an enlarged posterior cervical (neck) node for five months, had high risk exposure but have repeatedly tested neg for HIV. Query: My node biopsy was unsuccessful. The general surgeon opened my neck and poked around for an hour or so. He said he was going to close me and recommend that I get general anesthesia at the hospital to get the node out. Is this at all usual? He said that sometimes the node, even if it feels right under the skin, can be under the muscle. I've been having occasional night sweats and lost some weight, although I have gained it back)

Response from Dr. Dezube

There are really two elements to your question-- 1) Should you get the lymph node out? 2) What's the best way to accomplish this?

Although there are no firms rules as to when to have a lymph node biopsied, doctors are more likely to be concerned about a lymph node if one node is way bigger than the others, if a patient has systemic symptoms (e.g. fever, night sweats, weight loss), if a patient is older (e.g., a 60 year old with a lymph node is more worrisome than a 20 year old). A biopsy helps determine if the lymph node is just a benign enlargement (what we call a reactive node), has cancer (e.g. lymphoma, Hodgkin's, and others), has an infection, or is something else. The vast majority of lymph nodes, particularly in younger folks, are reactive (i.e., benign) in nature.

What's the best way to accomplish this? Have you had a neck CT scan? This is probably one of the best ways to accurately determine exactly where the lymph node is, what structures it is by, and what's the best way to remove it.


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