Enlarged Lymph Nodes

What Are Lymph Nodes?

Lymph nodes are small organs of the lymphatic system that play an important role in the immune response. They filter lymph and help the body respond to infections, inflammation and abnormal cells, including cancer cells.

Lymph nodes are found throughout the body and usually occur in groups associated with particular anatomical regions. Important groups include cervical lymph nodes in the neck, axillary lymph nodes, supraclavicular and infraclavicular lymph nodes, inguinal lymph nodes and lymph nodes located within the abdomen, pelvis and retroperitoneum.

 

 

Superficial lymph nodes can often be assessed during a physical examination, while imaging is used to evaluate their size and internal structure in greater detail. Ultrasound is one of the main examinations used for superficial lymph nodes. Deeper lymph nodes may require assessment with CT, MRI or other imaging techniques.

 

Enlarged Lymph Nodes – Lymphadenopathy

Enlarged lymph nodes, also known as lymphadenopathy, are a common clinical finding. In many cases, lymph node enlargement is a temporary response of the immune system to infection or inflammation. In other situations, further diagnostic assessment may be required.

The significance of an enlarged lymph node depends not only on its size but also on its location, how long it has been present, its appearance on ultrasound, associated symptoms, the patient's age and the results of other examinations.

 

Common causes of enlarged lymph nodes include:

• infections and inflammation – including viral and bacterial infections, dental infections, upper respiratory tract infections, infectious mononucleosis, toxoplasmosis and local skin infections,
• post-vaccination reactions,
• autoimmune diseases,
• chronic inflammatory conditions,
• malignant disease – including lymphoma, leukaemia and metastatic involvement of lymph nodes by solid tumours.

 

Ultrasound of Enlarged Lymph Nodes – Normal, Reactive and Suspicious Nodes

During a lymph node ultrasound examination, the doctor assesses not only the size of the node but also its shape, long-to-short axis ratio, fatty hilum, cortical thickness, internal architecture, vascularity and surrounding tissues.

Based on these features, lymph nodes may have an appearance typical of normal or reactive nodes, or they may show features that require further diagnostic assessment.

• Normal lymph nodes are usually oval in shape, with preserved internal architecture and a visible fatty hilum.
• Reactive lymph nodes may be enlarged due to infection or inflammation but usually retain features of normal lymph node architecture.
• Suspicious or pathological lymph nodes may show features such as a more rounded shape, loss or distortion of the fatty hilum, abnormal cortical thickening, pathological vascularity, necrosis or formation of nodal conglomerates. No single ultrasound feature alone, however, establishes a diagnosis of malignancy.

 

 

Lymph Nodes, Cancer and the TNM Classification

In many malignant tumours, assessment of lymph nodes is an important part of determining the stage of the disease. In the TNM classification, T describes the primary tumour, N describes regional lymph node involvement and M refers to distant metastases.

The significance of an involved lymph node depends on the type and location of the primary cancer. A lymph node considered regional for one type of cancer may have a different clinical significance in another malignancy.

 

Lymph Node Ultrasound in Gdańsk

For superficially located enlarged lymph nodes, one of the main imaging examinations is lymph node ultrasound. Ultrasound allows the doctor to assess the location, size and internal structure of the lymph node and determine whether observation, additional imaging or tissue sampling is required.

 

 

Types of Ultrasound Examinations Used to Assess Lymph Nodes

• Ultrasound of a selected lymph node group – for example cervical, axillary or inguinal lymph nodes,
• Breast ultrasound – also includes assessment of regional lymph nodes, particularly the axillary nodes,
• Thyroid and neck ultrasound – allows assessment of regional cervical lymph nodes,
• Abdominal ultrasound – may allow assessment of selected lymph nodes within the abdominal cavity and retroperitoneum,
• Transvaginal ultrasound – in appropriate clinical situations may also allow assessment of pelvic structures and selected pelvic lymph node groups.

If the ultrasound findings are inconclusive or the lymph nodes are located in an area that cannot be adequately assessed with ultrasound, additional imaging may be recommended.

 

How Is the Cause of Enlarged Lymph Nodes Diagnosed?

The diagnostic process includes a medical history, physical examination and appropriately selected laboratory and imaging tests. If the lymph node appears suspicious or the cause of enlargement remains unclear, material may need to be obtained for cytological or histopathological examination.

 

Fine-Needle Aspiration Biopsy (FNA) of a Lymph Node

Fine-needle aspiration biopsy (FNA) of a lymph node allows cells to be collected for cytological examination. It may be used, among other indications, when metastatic involvement of a lymph node by a solid tumour is suspected or when selected enlarged lymph nodes require further evaluation.

Biopsy of superficially located lymph nodes is commonly performed under ultrasound guidance, allowing precise placement of the needle within the lymph node.

 

Core Needle Biopsy (CNB) of a Lymph Node

Core needle biopsy of a lymph node involves obtaining small tissue samples using a special biopsy needle. The tissue can then be examined histopathologically and may provide more diagnostic information than cytology alone.

Core needle biopsy may be performed, among other indications, to confirm lymph node involvement by cancer, assess suspected recurrence within a lymph node or in other situations in which tissue architecture needs to be examined.

 

Surgical Excision of an Entire Lymph Node

In some situations, the most appropriate way to establish a diagnosis is surgical excision of the entire lymph node followed by histopathological examination. This allows the pathologist to assess the architecture of the whole lymph node rather than only individual cells.

This may be particularly important when lymphoma is suspected or when previous needle biopsies have not provided a definitive diagnosis.

A superficially located lymph node may, in appropriately selected cases, be removed under local anaesthesia.

 

Surgical Oncologist in Gdańsk – Lymph Node Biopsy and Excision

At Tartaczna 2 Medical Centre in Gdańsk, we provide diagnostic assessment of enlarged lymph nodes, lymph node biopsies and selected surgical procedures.

Fine-needle aspiration biopsy, core needle biopsy and surgical excision of selected superficially located lymph nodes are performed by surgical oncologists Dr Natalia Spychalska and Dr Kamil Drucis.

For lesions and lymph nodes located in the neck, diagnostic assessment and selected ENT procedures are also performed by Dr Agnieszka Kasprzyk-Tryk, specialist in otolaryngology.

 

Cytological and Histopathological Examination of Lymph Nodes

Material obtained during fine-needle aspiration biopsy is assessed cytologically, while tissue obtained during core needle biopsy or surgical excision of a lymph node is submitted for histopathological examination.

Cytological and histopathological assessment is performed by a specialist pathologist. At our Medical Centre, pathology consultations are provided by Dr Artur Antolak.

 

Lymph Node Ultrasound and Diagnostic Assessment – Doctors

Ultrasound examinations are performed by doctors from different specialties according to the anatomical region and clinical indication.

• Dr Ewa Kołyszko – radiologist,
• Dr Kamil Drucis – general surgeon and surgical oncologist; ultrasound may be performed as part of an appropriate consultation,
• Dr Marek Korożan – obstetrician-gynaecologist; transvaginal ultrasound,
• Dr Agnieszka Kasprzyk-Tryk – otolaryngologist; assessment of cervical lesions and lymph nodes.

 

Diagnosis and Treatment of Enlarged Lymph Nodes in Gdańsk

At Tartaczna 2 Medical Centre in Gdańsk, patients can undergo consecutive stages of enlarged lymph node diagnostics, including specialist consultation, ultrasound, fine-needle aspiration biopsy, core needle biopsy, surgical lymph node excision and cytological or histopathological assessment.

Appointments can be booked through our website (e-mail or telephone contact) or via ZnanyLekarz: Dr Kamil Drucis,  Dr Natalia Spychalska,  Dr Agnieszka Kasprzyk-Tryk.

 

Please note that the waiting time for a histopathology report is approximately 30 days.