Clinical investigations from the RACP

Assessing lymphadenopathy in adults: a systematic approach

Lay Tay, John Gibson



Lymphadenopathy is a common problem that, although often benign, can be the marker of a potentially serious but usually treatable underlying condition. Practical guidelines for assessing adults with this condition are described.

Key Points

  • Most lymphadenopathy is benign. In the primary care setting, only 1% of patients have an underlying malignancy.
  • A full history and examination supplemented by simple initial investigations and/or a period of observation may be sufficient in many cases.
  • A lymph node biopsy is indicated if lymphadenopathy is persistent and has features suggestive of malignancy, such as firmness, hardness or fixation to underlying structures, or if it is associated with systemic symptoms.
  • An excision biopsy of the lymph node will give the best chance of the precise diagnosis. However, a core biopsy or fine needle aspiration biopsy are alternatives if excision biopsy is unacceptably invasive.