Testing your lymph nodes for CLL

You might have a lymph node biospy to help your doctors diagnose or find out more about your chronic lymphocytic leukaemia (CLL).

The doctor either removes the whole lymph node, or they remove part of it. They then send it to the laboratory for testing.

Why you might have this test

It is not very common to test your lymph nodes in CLL. This is because your doctor usually makes the diagnosis from blood tests.

You might need a lymph node biopsy if, after a blood test, your doctor is still uncertain about your diagnosis.

Or you might need a biopsy if your doctor thinks your leukaemia might be changing (transforming) into a type of lymphoma called Richter’s syndrome. If they think you have Richter's syndrome then you will also have a PET scan. 

What is a lymph node?

A lymph node is part of the lymphatic system. This is a network of thin tubes (vessels) and nodes that carry a clear fluid called lymph around the body. This is an important part of the immune system. It plays a role in fighting infection and destroying old or abnormal cells.

The nodes are bean shaped structures that filter the lymph fluid and trap bacteria and viruses, and cancer cells.

The lymphatic system includes other organs, such as the spleen, thymus, and tonsils.

Types of biopsy

There are different types of lymph node biopsy for CLL:

Excisional biopsy

Your doctor takes out the whole lymph node. This is called an excisional biopsy.

You might have a local anaesthetic to numb the area before they take the biopsy. Or you might have the biopsy under general anaesthetic, which means you are asleep. It is a small operation that most people have as a day case. 

Your doctor makes a small cut above the swollen lymph node and removes it. They then send it to the laboratory for testing.

There are many lymph nodes throughout your body. So removing 1 or 2 doesn't usually cause any problems.

Incisional biopsy

This is similar to an excisional biopsy. But the doctor only removes part of the lymph node rather than removing the whole lymph node. 

What happens

Before your biopsy

You’ll get an appointment letter explaining how to prepare for your biopsy.

Take your medicines as normal unless you're told otherwise. If you're taking medicines to thin your blood, your doctor might ask you to stop them beforehand.

You meet with your doctor and sign a consent form before you have the test. This is a good time to ask them any questions.

If you’re having a general anaesthetic, you have to stop eating and drinking for a certain amount of time beforehand. You also need a friend or relative to take you home and stay with you overnight.

During your biopsy

You change into a hospital gown and lie on a couch.

Your doctor first cleans your skin on and around the lymph nodes. They then inject medicine to numb the area (if you're not having a general anaesthetic). The medicine can sting a little as it goes in.

Once the area is numb your doctor then finds the lymph node to take the biopsy from. They may be able to feel the swollen lymph node or they can find it using an ultrasound scan. They then make a cut and either remove part of or all of the lymph node. They close the cut with a few stitches.  

After your test

You should be able to go home the same day.

You have a small dressing over the site. Ask your doctor or nurse how to look after this for the next few days.

Check with your doctor if they have used dissolvable stitches or not. For non dissolvable stitches book an appointment with your GP surgery for the practice nurse to take out. Your doctor will tell you when is best to do this. 

Possible risks

A lymph node biopsy is a safe procedure but your doctor or nurse will tell you who to contact if you have any problems after your test. Your doctors make sure the benefits of having a lymph node biopsy outweigh any possible risks.

Pain

You might have some mild pain or discomfort around the site. Taking a painkiller such as paracetamol can help.

Bleeding

There is a small risk of bleeding. Your doctor can normally control this by pressing on the area. If there is a lot of blood from the biopsy site, let your doctor know straight away or go to your nearest accident and emergency department (A&E).

Infection

Contact your GP or the hospital if you have a high temperature or feel unwell. Or if there is redness, swelling or fluid (discharge) at the biopsy site.

Getting your results

It takes 1 or 2 weeks to get the results. Your specialist will usually discuss them with you at your next clinic appointment.

Waiting for test results can be a worrying time. You might have contact details for a specialist nurse. You can get in touch with them for information and support if you need to. It may help to talk to a close friend or relative about how you feel. You may want them to go with you to get the results for support.