Supra-clavicular Lymph Node biopsy

What are lymph nodes?

Lymph nodes are glands that are part of your immune system. They store cells and other parts of the immune system your body uses to fight infections.

What does supra-clavicular mean?

The supra-clavicular area is the space made between your collarbone, the side of your neck and the muscle that runs between the back of your neck and shoulder.

What is a biopsy?

A biopsy is a test where a small sample of tissue is taken from somewhere in the body. This is then prepared and looked at under a microscope. This can help to diagnose different illnesses.

Why am I having a supra-clavicular lymph node biopsy?

You have been asked to have this test because the lymph nodes in your supraclavicular area are enlarged (bigger than they should be).

What has caused these lymph nodes to become enlarged?

There are many possible causes of this. These can include:

• Cancer – Cancer in the head or neck can spread to the lymph nodes and cause them to swell.
• Infection – Infections in your neck and chest can cause the lymph nodes to swell up. There are many different bacteria that can cause this. One of the important ones we check for is tuberculosis.
• Inflammation – There are some rarer illnesses which can cause inflammation in your body tissues.

These can cause your lymph glands to swell up. The most common of these illnesses is one known as Sarcoidosis.

Will I need any other tests?

Yes, you will usually need other tests as well as this biopsy. These can include:

• CT scans:  These are detailed, 3 dimensional X-ray scans. You will most likely have had, or are going to have a CT scan.
  -This will usually be of your chest, neck or both. It might also include your abdomen and pelvis, depending on what the underlying problem is thought to be.
  -Most patients will receive a special dye called contrast (injected into a blood vessel) to improve the quality of the images.
  
• Blood tests:  Before the biopsy, we will normally check your blood clotting and your full blood count. This is to make sure that the risk of causing any serious bleeding is as low as it can be.
  -You may also have other blood tests to help to work out what the underlying cause is.

How do I get ready for the test?

You will be given an appointment for the test, which will usually take place in the Lung Health Outpatient Department at University Hospital of North Tees.

Before the test, you should consider:

1. If you are taking anticoagulants (blood thinning medication) or anti-platelets (medication which prevents blood clots forming), we will normally ask you to stop taking them for a certain number of days before your test.
   – Anticoagulant medications includes warfarin, apixaban, ruvaroxaban, dabigatran, edoxaban.
   -Anti-platelet medication includes clopidogrel, ticagrelor.
   -If there is any concern about stopping these medicines, the team will talk to the specialist who has prescribed them to come up with a safe plan.
   
2. You should take all of your usual medicines as normal on the day of the test (other than those mentioned in point 1).
   
3. Fasting (going without food or drink) – you do not need to fast before the test.
   
4. Clothing – wear loose comfortable clothes. You will be asked to change into a gown for the procedure itself.
   

How is the test done?

You will be shown into the procedure room and asked to change into a gown.

The Doctor doing the test will then talk you through the test and the risks and possible side effects. You will then be asked to sign a consent form.

Following signing of your consent form, the procedure is done as follows:

1. The Doctor will examine your neck to find the lymph node.
   -They will then use an ultrasound probe (a type of scan which uses sound waves to “see” inside your body) to examine the lymph gland.
   -This helps make sure that there are no arteries, veins or other important structures nearby which could be damaged with the biopsy.
   
2. The area will then be cleaned with sterilising solution.
   
3. A small amount of local anaesthetic will be injected under your skin to “numb” the area.
   
4. A needle will then be inserted into the lymph gland and “triggered” to take a sample. The Doctor may take several samples.
   
5. Pressure will be applied to the biopsy site, when any bleeding has stopped, a small dressing will be applied. 
   
6. You can then get dressed and after a short time, you can then go home.

What possible risks or side effects are there?

The test is very safe and the majority of patients have no problems. There are, however, some things you should know about.

• Pain: You may have some mild discomfort after the local anaesthetic has worn off. This usually settles within 24 – 48 hours. Simple painkillers such as paracetamol or ibuprofen will usually settle things.
  
• Infection: You can remove the dressing after 24 hours. Keep the area clean and dry.
  – The biopsy site usually heals fully within 5 – 7 days. It is rare to develop an infection at the biopsy site. However, if you notice your skin becoming red, inflamed, swollen, hot to touch or pus coming from the site, you should immediately contact your GP, out of hours Doctor or accident and emergency department for assessment.
  
• Bleeding: You may have a bruise at the site of the biopsy. This usually clears within 5 – 7 days.
  – Less commonly, you may develop a larger swelling or collection of blood called a “haematoma”. This can take 2 – 4 weeks to settle but does not cause any long lasting problems.
  – It is extremely rare to have any more serious bleeding.
  
• Pneumothorax: (collapsed lung): The top of your lung sits underneath the supraclavicular area.
  -Extremely rarely, the needle taking the biopsy of your lymph gland can damage the top of your lung. This can cause air to leak out of your lung into the chest cavity, causing the lung to collapse.

If you develop any breathlessness after the biopsy, you should go to Accident and Emergency, as you may need a chest X-ray to check your lungs.

• Nerve damage: There are nerves which run from your neck to your arm. They don’t usually pass through your supraclavicular area.
  – Extremely rarely, some patient’s nerves don’t follow the usual or expected course through the neck and shoulder.
  – This is very uncommon. The Doctor performing the tests may ask if you have had any operation or procedures to your neck or shoulder, which may have affected the area.
  – If this has been then case, the biopsy could then damage nerves and lead to pain, loss of sensation and loss of function in the arm. It is extremely rare for this to happen.
  
• Death: There is an extremely small chance of death due to injury of the lung or blood vessels. This risk is very small as the procedure is done using the ultrasound probe, which allows the Doctor doing the biopsy to “see” and avoid anything that could potentially be damaged.

Will this test definitely give an answer?

There may be other tests. This will depend on what your tests have shown. If there are other glands in your armpit, chest or other abnormal areas, it may be possible to biopsy them.

This test has been chosen for you because it is thought that it will give the best chance of a diagnosis, with the least risk to your health.

What if I am pregnant?

If you are pregnant, you can still have this test. It does not use radiation or any medication which could be harmful to your pregnancy.

What if I need an interpreter?

If you need an interpreter, please let us know and we will arrange one. It is the Trust policy that family and friends cannot act as an interpreter for procedures.

Will I go home the same day?

Yes, providing you have no problems during or after the test.

When will I get the results?

The results of the biopsy are usually reported within 5 – 7 days. The Doctor who has asked for the test will let you know the results when they have them.

Can I drink alcohol after the test?

Yes, that is not usually a problem.

Can I travel after the test?

Yes, providing you are feeling well.

When can I go back to work?

If you are well, you can go to work the following day.

Comments, concerns, compliments or complaints

Patient Experience Team (PET)

We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. The office is based on the ground floor at the University Hospital of North Tees if you wish to discuss concerns in person. If you would like to contact or request a copy of our PET leaflet, please contact:

Telephone: 01642 624719

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Leaflet feedback

This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, TS19 8PE or:

Email: [email protected]

Leaflet Reference: PIL1368
Date for Review: 09/02/2024