From the Guidelines
To examine lymph nodes, start by using a systematic approach with gentle palpation using the pads of your index and middle fingers, as this method allows for the detection of abnormalities such as enlargement, tenderness, hardness, fixation, or matting together 1.
Key Steps in Lymph Node Examination
- Begin with the head and neck region, examining the preauricular, postauricular, occipital, tonsillar, submandibular, submental, anterior cervical chain, posterior cervical chain, and supraclavicular nodes.
- Proceed to the axillary, epitrochlear, and inguinal regions, applying light to moderate pressure in a circular motion.
- Note any nodes that are enlarged (normal is usually less than 1 cm), tender, hard, fixed to surrounding tissues, or matted together.
Positioning for Examination
- For cervical nodes, position the patient with their neck slightly flexed toward the side being examined to relax the muscles.
- For axillary nodes, have the patient relax their arm while you support it and palpate the central, pectoral, subscapular, and lateral groups.
- For inguinal nodes, have the patient lie supine while you examine horizontal and vertical chains.
Identifying Abnormal Findings
- Abnormal findings include significant enlargement (>1-2 cm), hardness, fixation, tenderness, or asymmetry.
- These characteristics help distinguish between reactive lymphadenopathy (often soft, mobile, and tender) versus potentially malignant nodes (typically hard, fixed, and painless) 1.
Radiographic Assessment
- Lymph nodes are considered as a separate organ to measure, with up to two lymph nodes measured 1.
- The short axis of the lymph node should be measured at baseline and at every follow-up scan, with a short-axis diameter larger than 15 mm considered pathologically enlarged and measurable at baseline 1.
From the Research
Examining Lymph Nodes
To examine lymph nodes, several factors must be considered, including the patient's age, clinical history, physical examination, and anatomic location of the nodes 2.
Diagnostic Factors
The diagnostic factors used to evaluate the etiology of one or more enlarged lymph nodes include:
- The age of the patient
- The clinical history
- The physical examination
- The anatomic location/nodal history and characteristics 2
Predicting the Necessity of Biopsy
In young patients, the necessity of lymph node biopsy can be accurately predicted using parameters such as:
- Abnormal chest X-ray
- Lymph node > 2 cm
- Ear, nose, and throat symptoms 3 In adults, the necessity of biopsy may be reliably predicted using parameters such as:
- Age
- Lymph node tenderness
- Lymph node size
- Consistency
- Presence of supraclavicular lymph nodes
- Generalised pruritus 3
Lymph Node Examination Techniques
Different techniques can be used to examine lymph nodes, including:
- Intraoperative examination with frozen section (FS) or imprint cytology (IC) 4
- Examination by a surgicopathologic team 5
- Sentinel lymph node (SLN) biopsy 4
Importance of Lymph Node Examination
The retrieval of lymph nodes is crucial for accurate staging and detection of metastatic lymph nodes, particularly in cancer patients 5, 6. The number of retrieved lymph nodes (RLNs) affects the likelihood of detecting metastatic lymph nodes (MLNs) 5.
Videos and Online Resources
While there are no specific videos mentioned in the provided studies, online resources and medical education websites may offer instructional videos and tutorials on how to examine lymph nodes. However, it is essential to consult reputable sources and medical professionals for accurate and up-to-date information.