Hi all,
I was tentatively scheduled at MDACC for a partial glossectomy and partial neck dissection on the right side (same side as the tumor), removing only lymph nodes on levels 1, 2, and 3. Now I've been told that 3 "suspicious" nodes showed up on the CT scan; 2 on the left side of my neck, one on the right. They want to do an "ultrasound guided fine needle aspiration" of at least the 3 suspicious nodes before surgery, in case the surgery plans need to be changed. Can anyone tell me how this procedure is done, and what "suspicious" really means?

Thanks,
Joy

Hi Joy,
The procedure itself uses a small diameter needle (actually called a "cannula"), to draw some lymphatic fluid from the node for pathological analysis. The needle is guided by viewing the "region of interest" with an ultrasound system and visualizing the correct positioning of the needle. They should, at least, give you a local for that.

"Suspicious" can mean many different things, my take would be that the lymph nodes in question are larger than 1 cm. Lymph nodes swell up all the time when we have infections so don't freak out yet. They are being cautious and conservative.

Thanks, Gary, I feel a little better. It sounded like I would get to avoid radiation for now, but with this new development I am not sure. But like you said, I won't freak out yet.

Joy,
I had this procedure done about 9 months ago. My head and neck CT turned up a suspicious spot on my lung so they did a chest and abdomen CT scan which ultimately indicated an enlarged lymph node in my abdomen. They did a CT-guided fine needle aspiration to check the node for cancerous cells.

Assuming the head and neck procedure is pretty simimilar to the abdominal one, they put you in the CT machine, roll you under the imaging head until the section of your head and neck appears on the monitor. Then, they start to insert the needle and constantly take images to make sure that the needle is on target and not near anything that could cause problems (like arteries). The procedure is relatively painless. Of course no one likes needles but it is roughly comparable to getting a needle vacination, although the needle is stuck in you for a longer period of time.

Once the lymph node is penetrated, they will draw lymphatic fluid from the node, add stain and then test it under a microsope for cancer. At my procedure, they took the fluid and told me within 5 minutes of drawing it, that the preliminary results were good but that it needed to be confirmed by the pathologist doing a more thorough assessment.

With a local anaesthetic, the whole procedure lasted about 25 minutes and was relatively painless, orders of magnitude easier than radiation. Good luck with your test. - Sheldon.