From the Guidelines
A flat, moveable, non-tender lymph node is usually benign, but it's crucial to consult a healthcare provider for a thorough evaluation to rule out any potential concerns. The characteristics of a lymph node being flat, moveable, and non-tender are generally considered reassuring signs, as opposed to nodes that are fixed, hard, or painful 1. According to the study by Evison et al, cited in 1, lymph node size is a strong predictor of etiology, with nodes 15 mm or less in short axis typically being reactive, and those greater than 25 mm being more likely to be pathologic.
Some key points to consider when evaluating a lymph node include:
- Size: Nodes larger than 1 cm in short axis may be more concerning 1
- Texture and density: Benign nodes usually have smooth and well-defined borders, uniform attenuation, and a central fatty hilum 1
- Clinical history: The presence of symptoms like fever, night sweats, or unexplained weight loss can increase the concern for a malignant process 1
- Location: The location of the lymph node can also impact the risk assessment 1
It's essential to have a lymph node evaluated by a healthcare provider if it persists for more than 2-4 weeks, continues to enlarge, or is accompanied by other symptoms. The provider can determine if further testing, such as blood work, imaging, or biopsy, is necessary 1.
From the Research
Lymph Node Characteristics
- A flat feeling, moveable, non-tender lymph node is often considered benign 2
- Benign lymphadenopathy can be caused by various non-neoplastic, non-infectious etiologies, including reactive lymphoid hyperplasia, dermatopathic lymphadenitis, and Rosai-Dorfman disease 2
Diagnostic Approaches
- Fine-needle aspiration (FNA) biopsy is a useful diagnostic modality for evaluating lymphadenopathy, providing cytomorphological information to guide treatment and management 2
- Ultrasound-guided core needle biopsy and core needle biopsy with fine-needle aspiration are also effective methods for obtaining tissue samples for diagnosis 3
- Imaging studies, such as axillary ultrasound, can help detect metastasis to level II and III axillary lymph nodes after axillary lymph node dissection for invasive breast cancer 4
Differential Diagnosis
- Benign lymphadenopathy can be distinguished from malignant lymphoma through a combination of clinical findings, immunohistochemical stains, and molecular studies 5
- Reactive lymphoid hyperplasia, for example, can be differentiated from follicular lymphoma through assessment of bcl-2 staining and molecular studies to demonstrate B-cell clonality 5
- Kikuchi-Fujimoto disease, a benign condition, can be confused with non-Hodgkin lymphoma, but clinical and morphologic features, such as the presence of abundant karyorrhectic debris, can help establish the correct diagnosis 5