Lymphadenopathy for investigation

Emergency referrals

All urgent cases must be discussed with the on call Haematology registrar or after hours the on call consultant. Contact through Royal Brisbane and Women's Hospital switch (07) 3646 8111 or The Prince Charles Hospital switch on (07) 3139 4000 to obtain appropriate prioritisation and treatment.

Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Central Patient Intake Unit: 1300 364 952.

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

  • Abnormal lymph node detected clinically or via imaging – and not biopsied (or inconclusive biopsy). For optimum care, patient should be seen within 2 weeks.
  • And IF ANY of the following are present (for optimum care, patient should be seen within 2 weeks):
    • symptomatic lymphadenopathy
    • raised LDH
    • bulky disease (> 7cm diameter of LN mass)
    • presence of fever, night sweats, weight loss or new onset pruritus
    • concurrent recent onset cytopenias (e.g. anaemia, thrombocytopenia)
    • extranodal masses
    • clinical history of rapid growth
  • And IF ALL the following are present:
    • 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 days is desirable

  • No category 2 criteria

Category 3

Appointment within 365 days is desirable

  • No category 3 criteria

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

  • 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

Other important information for referring practitioners

  • Suspect 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 recommended
    • Consider biopsy
    • 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.

Referral requirements

A referral may be rejected without the following information.

  • General referral information
  • Detailed history of present signs and symptoms
  • Past medical history/pertinent social history
  • Current medications and allergies
  • Histology report
  • FBC, U&E and LDH results

Out of catchment

Metro North 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 North 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.

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander
  • 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
  • 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
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use
  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • 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.)
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