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Forum Name: Lymphoma

Question: False Negative After Fine-Needle Aspiration?


 roolyn - Sun Jan 18, 2009 2:49 am

Hello. I am a 25 year-old female with no known medical conditions and I am not currently on any medication. I am concerned about an inguinal lymph node that has been enlarged and slowly growing for at least two years.

Two years ago I had an emergency appendectomy. The CT scans from that time show that one of my left inguinal lymph nodes was enlarged, though I do not know what the dimensions were. Because I was suffering from an acute infection, the radiologist did not even bother to note the enlarged node on the report, as enlarged nodes were to be expected. Now, more than two years later, I have recently undergone another CT scan to check for an incisional hernia (came back negative), and the node is not only still enlarged, but has grown noticeably. As of two months ago, the node was 2.6 cm X 2.9 cm X 2.9 cm in size. It is too deep for the physician to easily feel. I wouldn't say it is painful, but is is slightly tender to the touch and occaisionally gives me some discomfort when I sit for long periods of time.

I underwent a fine-needle aspiration which came back negative for cancer cells. My doctor says that he does not know why the lymph node continues to grow, and suggested a follow-up ultrasound in a few months to see it there is any change.

I have three basic questions:

1) What are the chances of a false-negative result when a fine-needle biopsy is performed? I am so concerned about this possiblity that I almost wish I had insisted on removal of the entire node for testing. I was told that they took six samples of tissue during the FNA . . . is that enough to be sure of the results?

2) What are the possible causes for this persistently growing lymph node? I have no fever, fatigue, etc. (nothing indicative of infection, in other words) and am a generally healthy person. If it's not resulting from cancer or an infection, what could be causing it?

3) How long should I wait to have a follow-up ultrasound to check for continued growth? It has been two months since the biposy . . . is it time to have it checked out? If there has been additional growth, what should the next step be?

I apologize for the lengthy, detailed post, but I do appreciate your time. I am very concerned about this lymph node, and even more concerned at the delay in diagnosis if there ends up being a problem after all. I would like some direction as to how to handle this situation and come to a final diagnosis.

Thanks again!
 Vonwebster - Fri Jan 23, 2009 10:10 am

Hi,

I'm afraid I'm no expert, but as far as FNA goes the possibilities of six FNA's all giving false negatives seem astronomical. A read around suggests that an FNA test has somewhere between a 5-10% false negative rate. When I had an FNA done and it came back negative, the surgeon told me that in cases of false negatives the result is usually somewhat suspicious or reads as "inconclusive". SO I wouldn't over worry on that count.

Also it sounds like the growth of this node is extremely so in which case a month or so's wait wouldn't be too much of a big issue. I'm hoping for the best for you :)

G
 roolyn - Fri Jan 30, 2009 2:08 pm

A brief update to my original post:
I have been experiencing more and more discomfort from this lymph node when in a sitting position, and I often feel that it is pressing on a nerve running down my leg. I went to see my surgeon again this week, and we took another look at my CT scans. I was told for the first time that I have a very large cyst on my left ovary (the lymph node that has been giving me trouble is also on the left side) and the cyst, too, has been growing slowly for years. This cyst was present, though smaller, on my CT scans from two years ago, and is considerably bigger now. We decided that to be on the safe side (and because of the pain and discomfort I've been experiencing) that surgery to remove the entire lymph node is the best option at this point. I'm currently waiting to hear back from my surgeon, as he is conferring with a gynecologist as to the cyst situation. It seems likely that the cyst will be removed for testing at the same time as the lymph node. Now, of course, I'm concerned about the possibility of ovarian cancer as well as the lymph node situation, and can't help but wonder if there is some correlation between the two. Anyone had a similar experience?

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