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Lymphadenopathy for investigation

Useful management information

  • Suspected spinal cord compression, superior vena cava syndrome (SVC), high calcium (>3.0mmol/L), febrile neutropenia need to be referred to the emergency department urgently.
  • Haematology department accepts referrals of patients with clinically abnormal lymph nodes without a biopsy
  • For clinically stable small - volume lymph nodes and in a well patient with normal blood work suggest:
    • clinical monitoring and consider a FNA or core biopsy if technically feasible.
    • for isolated neck lymphadenopathy, fine needle aspiration is usually the first investigation to exclude head and neck squamous cell cancer. Excisional biopsy of isolated neck lymph nodes should only be undertaken once squamous cell cancer has been excluded
  • Optimal cancer care pathway for people with Hodgkin and diffuse B-cell lymphomas
  • Quick reference guide

Minimum referral criteria (Does your patient meet the minimum criteria?)

Does your patient meet the minimum referral criteria?

Category 1
(appointment within 30 calendar days)

If you feel your patient meets Category 1 criteria, please mark "urgent" on your referral

  • Abnormal lymph node (LN) detected clinically or via imaging – and not biopsied (or inconclusive biopsy).
  • If ANY of the following are present the patient should ideally be seen within 2 weeks
    • symptomatic lymphadenopathy
    • raised LDH
    • bulky disease (>3cm diameter of LN mass)
    • presence of fever, night sweats, weight loss or new onset pruritus
    • concurrent recent onset cytopenia's (e.g. anaemia, thrombocytopenia)
    • extranodal masses
    • clinical history of rapid growth
  • If ALL the following are present an appointment within 4-6 weeks is acceptable:
    • Asymptomatic or minimally symptomatic lymphadenopathy
    • Normal FBC and stable creatinine and liver function
    • Clinical history of slow growth
    • Non bulky disease
    • Clinically well (absence of the following - fever, night sweats, weight loss or pruritus)
Category 2
(appointment within 90 calendar days)
  • Some patients who are clinically well with stable minor enlargement of LN and normal blood counts may be triaged as a cat 2
Category 3
(appointment within 365 calendar days)
  • No category 3 criteria

If your patient does not meet the minimum referral criteria

  • Consider other treatment pathways or an alternative diagnosis
  • If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested:
    • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
    • Please note that your referral may not be accepted or may be redirected to another service

Standard referral information (To be included in all referrals)

Reason for request

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

Relevant clinical information about the condition

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • All conservative options that have been pursued unsuccessfully prior to referral
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
  • Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use
  • A comprehensive capture of information in relation to MSH Referral Criteria

Clinical modifiers

  • The presence of clinical modifiers may impact the categorisation of the patient.
  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living functioning – low/medium/high
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

Patient's Demographic Details

  • Full name (including aliases)
  • Date and country of birth
  • Residential and postal address including whether patient resides at an aged care facility
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Name of delegate and contact details (Department of Corrective Services)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Other relevant information

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)


Essential referral information for Lymphadenopathy for investigation referrals (Referral will be returned without this)

  • General referral information
  • Detailed history of present signs and symptoms
  • Past medical history/pertinent social history
  • Current medications and allergies
  • FBC ELFTs LDH CMP results

If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons a Clinical Override may be requested. This reason must be clearly articulated in the body of the referral.

Additional referral information for Lymphadenopathy for investigation referrals


Out of catchment

Metro South Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro South Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

Last updated 28 May 2021