Which procedures are indicated in the workup of lymphadenitis?

Updated: Feb 12, 2019
  • Author: Elizabeth Partridge, MD, MPH, MS; Chief Editor: Russell W Steele, MD  more...
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Lymph node biopsy (see the image below), either partial or excisional, should be considered in cases in which lymphadenitis is not obviously related to an infectious cause, lymph nodes have remained enlarged for a prolonged period (4-6 wk), lymph nodes are in a supraclavicular location, lymph nodes have firm/rubbery consistency, ulceration is present, the patient has not responded to antibiotic therapy, or the patient has systemic symptoms (eg, fever, weight loss).

A lymph node biopsy is performed. Note that a mark A lymph node biopsy is performed. Note that a marking pen has been used to outline the node before removal and that a silk suture has been used to provide traction to assist the removal.

Fine-needle aspiration (FNA) is a technique used to obtain specimens for diagnostic testing. If malignancy is suspected, partial or excisional biopsy is preferred over FNA as FNA sampling may be inadequate for diagnosis.

Incision and drainage is the treatment for lymphadenitis with abscess formation. For atypical mycobacterial lymphadenitis, neither incision and drainage nor FNA should be performed as either of these may increase the risk of fistula formation and drainage.

A study reported on the accuracy and safety of endobronchial ultrasound (EBUS) transbronchial needle aspiration (TBNA) for the diagnosis of tuberculous mediastinal lymphadenitis. The study concluded that EBUS-TBNA is a safe and well tolerated procedure in the assessment of patients with suspected isolated mediastinal lymphadenitis. The authors add that EBUS-TBNA should be considered the procedure of choice for patients in whom TB is suspected. [10]

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