Inguinal Biopsy Needed?

Wasn't sure exactly where this question fits... my doctor and a surgeon she sent me to want to do an inguinal lymph node biopsy because of a swollen, tender node (it's been swollen for over a year and is between 1.5 and 2 centimeters long. It seems firm but mobile). I had an abdominal CT scan a few months ago for an unrelated (?) pain in my abdomen and it didn't show any problems. The dr.s said from what they could see on the CT scan they don't think I have a tumor but they still want to do a biopsy. Hopwever if it's unlikely to be cancer I really don't want to have this surgery especially because I am afraid of lymphedema. They also tested for various infections inc. STDs and found nothing. What are my options if I don't have the surgery? Should I have it despite the risks or should I talk to them about another option, and if so, what? It just feels like maybe we are jumping the gun but I'm not the expert. Aren't there any other ways to see what might be wrong with the lymph node?

[Fernando Roque, MD]

Hi.  You have every right to refuse the biopsy procedure, if that is really what you want.  However, I do think that the suggestion of your doctors to have the biopsy done is sound medical advice.  Any lymph node which has remained enlarged for a prolonged period of time should be checked for possible malignancy through a biopsy.  The fact that no tumor was found on abdominal CT does not prove that the enlarged node is more likely benign.  Only a biopsy can determine if that node is malignant or not.

Excising a single 2 cm node in the inguinal area, if done by a skillful surgeon, should not result in permanent lymphedema.  The inguinal area has several alternative routes through which the lymph may drain, and damage to just one or two lymphatic vessels as a result of the surgery should not result in permanent blockage of the lymphatic flow.  If you decide not to have the biopsy done, your option is to observe that node for a few months to see if there is any further increase in size.  If there is, then that would be the time to have the biopsy done.