Lymph Node Biopsy – Anatomy & Physiology

Lymph nodes are numerous in the head and neck region. They are a filter for bacteria and viruses but occasionally can become involved either by a malignancy involving the lymphatic system ‘lymphoma’, or as a result of spread of malignancy from the head and neck region.

The lymphatics are referred to according to their position in the Head and Neck region.

Level I – Submental and submandibular

Level II – Upper deep cervical

Level III – Mid deep cervical

Level IV – Lower deep cervical

Level V – Posterior triangle

Level VI – Paratracheal

Level VII – Superior mediastinal

Lymph Node Biopsy – Lymphadenopathy

If someone has persistent lymphadenopathy a cause should be sought. Most commonly lymph nodes are reactive to a variety of infective or inflammatory conditions. It is important that if a lymph node is seen in the neck this should be investigated thoroughly by a surgeon used to the examination of the upper aerodigestive tract. A full oral examination and flexible nasendoscopy should be performed. A Fine needle aspiration should be undertaken of the lymph node to gauge if it harbours malignant cells.

If a lymph node is to be biopsied a suitable one with minimal risk to the patient should be undertaken. Again a surgeon who regularly operates in the Head and Neck will be able to explain to the patient risks associated with a lymph node biopsy. Normally a small incision is made and the lymph node or a group of lymph nodes is sampled and sent for histology.