From the Guidelines
A lymph node is typically soft upon palpation, but can become hard in response to infection, inflammation, or malignancy. When examining lymph nodes, it's essential to consider their consistency, size, tenderness, location, and whether they are fixed to surrounding tissues. According to the guidelines for penile cancer management, palpable lymphadenopathy at diagnosis does not necessarily indicate metastatic disease, as 30% to 50% of cases may be due to inflammatory lymph node swelling instead of metastatic disease 1.
Key characteristics of lymph nodes that are important for diagnosis include:
- Size: Healthy nodes are usually small (less than 1 cm in diameter)
- Consistency: Soft and pliable in healthy nodes, but can become firm or hard in response to infection, inflammation, or malignancy
- Mobility: Healthy nodes are usually mobile, whereas nodes that are fixed to surrounding tissues may indicate malignancy
- Tenderness: Tender nodes are more typical of acute infection, while painless nodes may raise concern for malignancy
In clinical practice, the distinction between reactive lymph nodes and metastatic disease can be made after a 6-week course of antibiotics or through fine-needle aspiration, which is becoming a favored approach among many clinicians 1. The texture of lymph nodes provides valuable diagnostic information, and any abnormalities should be further investigated to determine the underlying cause.
From the Research
Lymph Node Characteristics
- A lymph node is typically soft upon palpation, but malignancy should be considered when palpable lymph nodes are identified as rock hard, rubbery, or fixed in consistency 2.
- The consistency of a lymph node can be an indicator of its potential malignancy, with rock hard, rubbery, or fixed nodes being more suspicious 2.
Lymph Node Evaluation
- Lymph nodes larger than 1 cm in diameter are generally considered abnormal 2.
- The evaluation of lymphadenopathy should include a search for a precipitating cause and an examination of other nodal locations to exclude generalized lymphadenopathy 2.
- Computed tomography is the method of choice for the evaluation of lymphadenopathy, as it is able to demonstrate increased size of individual nodes and other abnormalities 3.
Lymphadenopathy Causes
- Lymphadenopathy can be caused by a variety of infectious, inflammatory, and neoplastic conditions 3.
- The most frequent infections resulting in lymphadenopathy are tuberculosis and fungal disease, particularly histoplasmosis and coccidioidomycosis 3.
- Sarcoidosis is a relatively frequent cause of lymphadenopathy in young adults, and can be distinguished from other diseases by the presence of multiple and symmetrical enlarged lymph nodes 3.