What is the proper technique for lymph node examination?

From the Guidelines

Proper lymph node examination requires a systematic approach using both inspection and palpation techniques, as recommended by the most recent guidelines 1. To begin, position the patient comfortably, with good lighting to observe for any visible swelling or asymmetry. Use the pads of your index and middle fingers to palpate in a gentle, circular motion, applying firm but comfortable pressure to feel the nodes against underlying tissues. Examine lymph nodes in a logical sequence including:

• Cervical (anterior and posterior chains)
• Supraclavicular
• Axillary
• Epitrochlear
• Inguinal regions When examining cervical nodes, have the patient slightly flex their neck to relax the sternocleidomastoid muscle. For axillary examination, support the patient's relaxed arm while palpating with your other hand. Note the size (measured in centimeters), consistency (soft, firm, or hard), mobility (fixed or mobile), tenderness, and distribution of any palpable nodes. Normal lymph nodes are usually less than 1 cm, soft, non-tender, and mobile. Abnormal findings include significant enlargement, hardness, fixation to surrounding tissues, tenderness, or matting (multiple nodes feeling connected), as noted in the guidelines 1. This systematic approach ensures thorough assessment and helps identify potential pathologies like infections, inflammatory conditions, or malignancies that may affect the lymphatic system. The use of fine-needle aspiration and/or excisional biopsy of nodes found to be enlarged by either clinical or radiologic examination is also recommended 1. Additionally, evaluation of pelvic lymph nodes with CT or MRI of the pelvis, as well as a chest CT scan to evaluate for pulmonary metastasis, may be necessary in certain cases 1. It is essential to prioritize the most recent and highest quality study, which in this case is the 2023 guideline from the Journal of the National Comprehensive Cancer Network 1.

From the Research

Lymph Node Examination Technique

To examine the lymph nodes, it is essential to understand the proper technique. The following steps can be taken:

• Identify the lymph node locations, including the cervical, axillary, and inguinal regions
• Use a systematic approach to examine each region, starting from the top and working down
• Use the pads of the fingers to palpate the lymph nodes, applying gentle pressure
• Note the size, shape, and consistency of the lymph nodes, as well as any tenderness or pain

Lymph Node Examination Findings

The examination of lymph nodes can reveal various findings, including:

• Enlarged lymph nodes, which can be a sign of infection or inflammation 2, 3
• Tender lymph nodes, which can indicate an infectious or inflammatory process 2, 4
• Fixed or matted lymph nodes, which can be a sign of a more serious underlying condition 3, 5

Diagnostic Considerations

When examining lymph nodes, it is essential to consider various diagnostic possibilities, including:

• Infections, such as bacterial or viral infections 2, 5
• Inflammatory conditions, such as autoimmune disorders or allergic reactions 3, 4
• Neoplastic conditions, such as lymphoma or metastatic cancer 3, 6
• Other conditions, such as lymphadenitis or lymphangitis 2, 4

Imaging and Laboratory Tests

In some cases, imaging and laboratory tests may be necessary to further evaluate lymph node findings, including:

• Ultrasound or CT scans to visualize the lymph nodes and surrounding tissues 3, 5
• Biopsy or fine-needle aspiration to obtain tissue samples for histopathological examination 3, 6
• Blood tests to evaluate for signs of infection, inflammation, or other underlying conditions 2, 4