A biopsy of shallow lymph nodes is usually short in time - for many patients, the procedure is completed in about 20 minutes. Local anesthesia is usually used, although the puncture is generally considered painless. If ultrasound control is used, then the doctor, using an ultrasonic sensor, specifies the location of the painful structure, puts a special mark, which is reflected on the monitor. The skin in the puncture zone is treated with an antiseptic, and then with an anesthetic, or an anesthetic is injected. The patient lies on the couch horizontally, or is in a sitting position. If a biopsy is performed in the neck, then it is fixed in a special way, and the patient is explained about the need to temporarily not perform swallowing movements. The patient must remain completely still during the biopsy.
After taking the required amount of biological material, the puncture zone is treated with an antiseptic. It may be recommended to apply a cold dry compress for half an hour.
There is no need for a long stay in the clinic, or placing the patient in a hospital: he can go home on his own if there are no other reasons for keeping him. For the first time after the procedure, it is important to avoid physical activity.
If a deep site biopsy is required, general anesthesia may be required. In such a situation, the patient after the diagnosis is not sent home, but remains in the clinic - from several hours to 1-2 days.
An open biopsy requires a special set of tools: in addition to a scalpel, these are clamps, a coagulating apparatus, and materials for suturing. This intervention lasts up to 60 minutes. The doctor selects the lymph node necessary for the biopsy, fixes it with his fingers, then performs a 4-6 cm incision in the skin. It dissects the subcutaneous fat layer, pushes the muscle fibers, the network of nerves and blood vessels. If it is required to remove one or more nodes during a biopsy, the surgeon preliminarily bandages the vessels to prevent bleeding, lymph leakage, and the spread of tumor cells (if we are talking about a malignant process). After removing the lymph nodes, the doctor sends them for examination, once again conducts an audit of the wound, and sutures the incisions. In some cases, a draining device is left, which is removed after 24-48 hours. Removal of sutures is carried out within a week. 
How is a lymph node biopsy performed?
Taking a biopsy in a particular lymph node may have its own characteristics, which depends on the location, the depth of the structure, as well as the presence of vital organs and large vessels near the damaged link.
- A biopsy of the lymph node in the neck can be prescribed for otolaryngological, dental problems - the most common causes of lymphadenopathy. If lymphadenopathy has an unclear origin, then ultrasound is prescribed first, and only after that, if necessary, a biopsy. Lymph nodes increase in malignant tumors, as cancer cells penetrate into the lymphatic vessels that drain a separate area. In the future, these cells settle in the filter nodes, like metastases, and begin to develop. Often in oncology, the defeat of the lymph nodes occurs "along the chain", which is perfectly determined by probing. A biopsy on the neck can be performed either with a needle puncture with the removal of material, or with an operative access with complete removal of the link for histological analysis.
- A sentinel lymph node biopsy for melanoma is performed similarly to a biopsy for breast cancer. If there is information about metastasis to distant organs and lymph nodes, then performing a biopsy is considered useless. In the absence of metastases, a sentinel node biopsy is warranted. It is usually done after the removal of the melanoma itself. It is possible to visualize the lymph node using various radiological methods.
- A biopsy of the axillary lymph node is performed with the patient in a sitting position, who raises his arm up and takes it back a little. Most often, this procedure is carried out with a lesion of the mammary gland: lymph flows through the vessels to the nodes located in the armpit on the same side. Such lymph nodes form a kind of axillary-nodal chain. Its defeat plays an important role in planning a treatment regimen for breast pathology. The study is also appropriate for melanoma or squamous cell carcinoma of the upper limb, with Hodgkin's disease. 
- A biopsy of the inguinal lymph nodes is performed from the position of the patient lying on the couch, the leg (right or left, depending on the side of the lesion) is retracted to the side. Such a study is most often prescribed for suspected tumor processes (cancer of the testicles, vulva, cervix, prostate, bladder, rectum), or if it is not possible to find out the cause of lymphadenopathy in other ways (for example, with lymphogranulomatosis or HIV- infections).
- A biopsy of the supraclavicular lymph node is always caused by suspicions of quite serious pathologies: in many cases, these are tumors - metastases of cancer or lymphoma located in the chest or abdominal cavity. The supraclavicular lymph node on the right side can make itself felt in tumor processes of the mediastinum, esophagus, lung. Lymph from the intrathoracic organs and the abdominal cavity approaches the lymph node on the left side. Inflammatory diseases can also cause supraclavicular lymphadenopathy, but this happens much less frequently.
- A biopsy of the mediastinal lymph node is performed in the projection area of the upper third of the intrathoracic tracheal region, from the upper edge of the subclavian artery or pulmonary apex to the point of intersection of the upper border of the left brachiocephalic vein and the middle tracheal line. The most common indications for mediastinal lymph node biopsy are lymphoproliferative neoplasms, tuberculosis, and sarcoidosis.
- A biopsy of a lymph node in the lung is a common procedure for cancer, tuberculosis, and sarcoidosis. Often, lymphadenopathy becomes the only sign of pathology, since many pulmonary diseases are asymptomatic. In any case, before establishing a definitive diagnosis, the doctor must perform a biopsy and obtain histological information.
- A biopsy of the abdominal lymph nodes is prescribed for suspected tumor processes in the gastrointestinal tract, organs of the female and male reproductive organs, and the urinary system. Often, enlarged abdominal lymph nodes are noted with hepatosplenomegaly. A biopsy is done for both primary and differential diagnosis. A large number of lymph nodes in the abdominal cavity are located parietal along the peritoneum, along the vessels, in the mesentery and along the intestine, near the omentum. Their increase is possible with damage to the stomach, liver, intestines, pancreas, uterus, appendages, prostate, bladder.
- A biopsy of the submandibular lymph node can be prescribed for pathologies of the teeth, gums, cheeks, laryngeal region and pharynx, if the cause of the lymphadenopathy cannot be found, as well as if metastases of the cancerous process or lymphoma are suspected.
- A biopsy for cancer of the lymph nodes is performed in the absence of metastases to distant organs and lymph nodes. Otherwise, the procedure is considered meaningless for the patient. If there is no distant metastasis, then they proceed, first of all, to the study of the first in the chain, the "sentinel" lymph node.
- A biopsy of the retroperitoneal lymph node is appropriate for malignant processes in the male and female genital area. Approximately 30% of patients already at the first stage of cancer have microscopic metastases in the lymph nodes that cannot be identified using computed tomography or markers. A biopsy is performed, as a rule, from the side where the primary tumor focus was located. The procedure is usually performed as part of a retroperitoneal lymphadenectomy.
- A biopsy of the intrathoracic lymph nodes is a mandatory study for suspected cancer of the lungs, esophagus, thymus, breast, lymphoma and lymphogranulomatosis. In the nodes of the mediastinum, metastases from the abdominal cavity, pelvis, retroperitoneal space (kidneys, adrenal glands) in advanced stages can also spread.
- Biopsy of the paratracheal lymph nodes is often performed in patients with lung cancer. Paratracheal lymph nodes are located between the upper mediastinal and tracheobronchial nodes. In the primary tumor process on the same side, they are divided as ipsilateral, and in the absence of a primary tumor, as contralateral.
Lymphatic fluid flows through the corresponding vessels. If cancer cells get into it, then they are, first of all, in the first lymph node of the chain. This first node is called the sentinel or signal node. If cancer cells are not found in the sentinel lymph node, then subsequent nodes should in theory be healthy.
Types of biopsies
There are several types of biopsy of the lymph nodes, which depends on the technique for removing the biomaterial. Some types of procedures are performed in stages: first, a needle puncture is performed, and then an open intervention, if the puncture was not enough for diagnosis. An open biopsy method is required if the result of cytology turned out to be uncertain, doubtful, approximate.
- Open biopsy of the lymph node is the most complex and invasive option for such a diagnosis. During the procedure, a scalpel is used, and the entire node is selected for research, and not just part of it. Such an intervention is often the only correct one if malignant processes are suspected.
- Puncture biopsy of the lymph node is a relatively gentle and painless procedure that does not cause much discomfort to patients. During the diagnostics, a mandrin is used, which plays the role of a stylet. With the help of a mandrin, the required amount of biomaterial is cut off and captured. Needle biopsy involves the use of local anesthesia, does not require the patient to be placed in a hospital.
- Excisional lymph node biopsy is a term often applied to an open biopsy performed under general anesthesia. The affected node is removed through an incision.
- Trepan biopsy of the lymph node involves the use of a special large needle with notches that allow you to remove a particle of tissue of the required size.
- A fine-needle biopsy of a lymph node is called an aspiration biopsy: it involves the use of a thin hollow needle device. Usually, the node is probed and pierced: if this is not possible, then ultrasonic control is used. As a rule, a fine-needle biopsy is prescribed if it is necessary to study the submandibular or supraclavicular lymph nodes, if metastases of lymphoid structures are detected.
Biopsy of lymph nodes under ultrasound control
Currently, experts consider the targeted puncture procedure, or the so-called “ultrasound-guided biopsy”, to be the most acceptable technique for lymph node biopsy.
We are talking about the process of removing a biomaterial sample, which is performed under ultrasound supervision: as a result, the location and insertion of the puncture needle is carried out more accurately and safely. This is extremely important for the doctor, since often a suspicious lymph node is located in deep tissues near vital organs, or is small, which greatly complicates the procedure.
Ultrasound observation helps to insert the instrument precisely into the required place, without the risk of damage to adjacent tissues and organs. As a result, the risk of complications is minimized.
In what way the required zone is visualized, the doctor determines. An additional advantage of the technique is not only safety, but also its cheapness: no ultra-modern and expensive equipment is needed.
A biopsy with ultrasound is especially recommended if it is necessary to examine not only the affected structure, but also to find out the peculiarities of the blood circulation near it. This approach will avoid injury to blood vessels, exclude the release of blood into the tissue.
For the procedure, special needles with end sensors are used. This simple device helps to clearly monitor the position of the needle and its progress.
The recovery period after such an intervention is faster and more comfortable for the patient.