One visit

Biopsy, read and consult

Results in 24 hours

Preliminary, not two weeks

No stitches

Local anesthesia only

Ultrasound guided

Straight to the node

First question

Usually it is your immune system doing its job

Lymph nodes swell because they are working. Infection and inflammation make them grow, and they often stay enlarged for weeks after the cause has passed. Here is how to tell a node worth watching from one worth sampling.

Common, benign causes

  • Viral infection. Mononucleosis in particular can make neck nodes very large. A mono test rules it in or out.
  • Bacterial infection. Cat scratch disease travels from the skin to the nearest node, usually in the neck or under the arm.
  • Inflammatory conditions. Chronic, such as lupus, or acute. Reactive lymphadenopathy has wide and varied causes.
  • Nothing at all. Some nodes are simply prominent, and you only noticed after losing a little weight.

Worth getting looked at

  • It has not gone away. Still there after two to four weeks, or still growing.
  • It feels hard or fixed. Firm, rubbery, or it does not move under the skin.
  • It sits above the collarbone. Supraclavicular nodes are the ones clinicians take most seriously.
  • Night sweats, fever, weight loss. Especially weight you did not intend to lose.

None of these signs means cancer. They mean the node is worth sampling rather than watching. A fine needle aspiration answers the question in one appointment, which is a very different experience from waiting and wondering.

The reason to biopsy

What we are actually looking for

The top reason to biopsy a lymph node, whether by fine needle aspiration or a core needle, is to rule out the worse possibility. Under the microscope there are three things a node can be telling us.

Not cancer

Reactive

A mixed population of normal immune cells in the proportions you would expect. The node is responding to something. This is the most common finding, and it is the answer most people come here hoping to hear.

Cancer of the node

Lymphoma

A malignancy of the cells that live in the lymph node: B cells, T cells, plasma cells and other immune cells. It can sit in one node, a chain of nodes, or part of a single node. Viral infections such as mono can mimic it closely, which is why the cells need to be read by someone who looks at them all day.

Cancer from elsewhere

Metastatic carcinoma

Cancer that started somewhere else and invaded the node. The type usually points back to the region it drained from, which is why a left breast cancer tends to appear in the left axillary nodes.

Two routes, same question

The difference is who reads your slides

In most of Los Angeles a lymph node biopsy is a referral to a hospital radiology department. A radiologist takes the sample, and a pathologist you never meet reads it days later.

Standard referral

Two visits, two specialists

  • Day 0. Referral and imaging
  • Day 3. A radiologist takes the sample
  • Day 12 to 14. Pathology report reaches your doctor
  • If the sample is short. You find out two weeks later and start over

About two weeks of waiting

With Dr. Nadelman

One appointment

One visit, one specialist

  • Day 0. Ultrasound, biopsy, slides read on site, consultation
  • Same day. If the sample is short she knows immediately and takes another
  • Within 24 hours. Preliminary results to you and your doctor
  • No second trip. You talk to the person who made the diagnosis

An answer inside of two days

Your appointment

What actually happens

A fine needle aspiration uses a needle thinner than the one used to draw blood. There is no incision and there are no stitches. Plan on about an hour.

01

Consultation and ultrasound

Dr. Nadelman examines the node and looks at it on ultrasound first, so she knows exactly what she is sampling.

02

The aspiration

Local anesthesia, then a few passes with a fine needle. Most people find it easier than a blood draw.

03

Read on site

The slides are stained and examined in the office lab while you wait. This is the step that does not exist anywhere else.

04

You get answers

Preliminary findings usually within 24 hours, sent to whichever physician you name.

Celina-M-Nadelman-MD
Who reads your slides

Celina M. Nadelman, M.D.

One of very few physicians in the United States who is board certified in cytopathology and practices as a fine needle aspiration specialist. She performs the biopsy and she interprets it. There is no handoff.

  • Head of the FNA Clinic for Los Angeles County at the Martin Luther King, Jr. Outpatient Center
  • Clinical instructor, UCLA David Geffen School of Medicine
  • Co-Director of Pathology, Charles R. Drew University
  • Residency and fellowship at UCLA. M.D., Keck School of Medicine of USC

Waiting is the worst part. It does not have to take two weeks.

Next-day appointments are usually available, and house calls are available anywhere in California.

310.702.6701

1125 S. Beverly Drive, Suite 602
Los Angeles, CA 90035
Monday to Friday, 10 to 6

Before you call

Questions patients ask

Does a fine needle aspiration hurt?

Less than most people expect. The needle is thinner than the one used for a blood draw, the area is numbed first, and there is no incision, so there is nothing to stitch and nothing to heal. Most patients drive themselves home and go back to work.

No. You can schedule directly with the office. If you do have a referring physician, Dr. Nadelman sends them the report and is glad to talk through the findings with them. Because she reads the slides herself, that conversation happens with the person who made the diagnosis.

She takes another one in the same visit. The slides are stained and examined in the office while you are still there, so a short sample is caught in minutes rather than discovered by an outside lab two weeks later.

For most lymph node questions, yes, and it is far less invasive. Where a diagnosis needs more tissue, Dr. Nadelman will tell you on the day and help arrange the next step rather than sending you back to the start.