Excisional Biopsy: Neck Lymph Node

The lymph nodes are part of the immune system. These small organs are located throughout the body. They're connected to each other by lymph vessels. There are a lot of lymph nodes in the neck. These nodes sometimes swell or become enlarged. Then you might be able to feel them under your skin. This swelling is most often caused by infection, but it can also be caused by cancer.

Excisional biopsy helps find the cause of an enlarged lymph node. You may have already had other tests, like imaging scans and a needle biopsy. But sometimes, more tissue is needed to diagnose the problem. During an excisional biopsy, the entire enlarged lymph node is removed. It's then sent to a lab for testing.

Side view of the neck and head showing the lymph nodes.
Many lymph nodes are found in the neck area. Your healthcare provider can show you which of your lymph nodes is affected.

Preparing for the procedure

Follow the instructions you were given to prepare for lymph node surgery. Be sure to tell your healthcare provider about all medicines you take. This includes over-the-counter medicines, herbs, vitamins, and other supplements. Also tell them if you use marijuana or illegal drugs. You may need to stop taking some or all these things before surgery. Also follow any directions you’re given for not eating or drinking before the procedure.

The day of the procedure

The procedure usually takes about 60 minutes. Most people go home the same day.

Before the procedure begins

Here is what to expect before surgery:

  • A small tube called an IV (intravenous) line is put into a vein in your arm or hand. This tube is used to give you fluids and medicines.

  • A thin needle might be used to inject local anesthesia into the area around the lymph node to numb it. You may also get medicine to sedate you. This will make you relaxed and sleepy, but you'll be able to breath on your own.

  • Sometimes general anesthesia is used to put you into a much deeper sleep. When you get general anesthesia, you'll need to have a breathing tube put in and will be on a breathing machine during the surgery.

During the procedure

Here's what to expect during the procedure: 

  • The skin over the enlarged lymph node is marked and cleaned.

  • A cut (incision) is made through the skin. If possible, the incision is made within the creases of your neck. This makes it less noticeable when it has healed.

  • The enlarged lymph node is taken out. It's sent to a lab for testing.

  • The incision is closed with stitches, staples, surgical glue, or surgical strips. Then it's bandaged.

  • A tube (drain) might be put in near the incision. This drains out fluids that may build up after the procedure.

After the procedure

You'll be taken to a recovery room to wake up from the anesthesia. You may feel sleepy and nauseated at first. You'll get medicine to help with any pain. If you have a drain, you'll be shown how to care for it. When you're ready to go home, have an adult family member or friend drive you. Follow your healthcare provider’s instructions for recovery, such as:

  • Take any prescribed medicine as directed

  • Do deep breathing exercises as instructed

  • Care for your incision and bandage as instructed

  • Try to get up and walk as much as you can

  • Don't do strenuous activity until your healthcare provider says it’s OK

When to call your healthcare provider

Call your healthcare provider if you have any of the following:

  • Chest pain or trouble breathing (call 911)

  • Swelling, redness, warmth, or pain in a leg or arm. These could be signs of a blood clot.

  • Fever of 100.4° F ( 38° C) or higher, or as directed by your healthcare provider

  • Soreness at the biopsy site that's getting worse

  • Trouble turning your head

  • Any increased redness or swelling, warmth, worsening pain, or foul-smelling drainage at the incision site. These could be signs of infection.

  • New bleeding or bruising at the incision site

  • Numbness or tingling in your mouth, jaw, neck, arm, or shoulder

  • Problems speaking or swallowing

  • Hoarse voice that worsens

Be sure you have a contact number for your healthcare provider so you can get in touch after office hours and on weekends if needed.

Follow-up

During follow-up visits, your healthcare provider will check on your healing. If you have a drain, it will be removed 1 to 2 days after the procedure. Stitches or staples are removed about 7 to 10 days after the procedure. You and your healthcare provider will also discuss your biopsy results. If cancer was found, further treatment may be needed.

Risks and possible complications

Risks of this procedure include:

  • Bleeding

  • Infection

  • Injury to the nerves near the lymph node

  • Neck abscess

  • Scarring

  • Reopening of the incision

  • Another enlarged lymph node

  • Risks of anesthesia. You will discuss these with the anesthesiologist.

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