Lymph nodes are part of the lymphatic channels. They are connected via lymphatic vessels and are present throughout the body. Lymph nodes are important in functioning of the immune system and consist of both B and T cells. They trap foreign particles and cancer cells.
They can become inflamed or enlarged in wide variety of conditions, from viral infections to life-threatening conditions like cancers. There are many causes of enlarged lymph nodes. Mostly diagnosis can be made on history, examination, blood tests and imaging, but at times excision biopsy is needed, especially to diagnose or exclude different types of lymphoma or sarcoidosis.
As a surgeon, I am mostly a technician, only required to perform an excision biopsy requested by another specialist. Usually in these cases patients are referred to me by different subspecialist like haematologist (blood specialist) or respiratory physician. At times I see the patients first, perform tests and request imaging and then perform excision biopsy for a diagnosis. Then I refer the patient to relevant specialty for treatment.
When excision biopsy is performed, this is done on the lymph nodes that look abnormal, but that are in easiest location for the biopsy. Most often excision of the groin or armpit is performed, as it is associated with less complications. The next most common excision biopsy performed is that of the neck lymph nodes. Often breast surgeons perform armpit (axillary) excision biopsy. Neck lymph node excision biopsy should be performed by surgeons who are trained to operate in the neck as this is a complex area (endocrine surgeons, thyroid surgeons, ENT surgeons).
Possible complications of excision of the lymph nodes:
Bruising – is common and disappears with time
Haematoma – blood can collect under the skin (haematoma) and cause swelling, discomfort and hardness. It usually resolves, but rarely may need surgery to remove it.
Wound Infection – this is also unusual. Things to look for are spreading skin redness, discharge from the wound or around the drain, worsening pain in the wound, warm and swollen wound and feeling unwell with flu-like symptoms.
Change in Sensation – some will occur in the skin because sensory nerves to this area have been affected by the surgery.
Seroma – fluid will collect in wound in small or larger quantities. If it causes discomfort it may need to be removed using a syringe. This is not a painful procedure.
Lymphoedema – swelling caused when lymph fluid accumulates in the surrounding tissue due to impaired function of lymphatic vessels (for more information see lymphoedema section on the breast page of this website).
Damage to surrounding structures – mostly nerves, but this depends on the area of the body that is operated on.