The decision to remove lymph nodes even if the biopsy comes back negative depends on several factors and should be made in consultation with a medical professional. Here are some considerations:

1. **Type of Cancer:** The necessity for lymph node removal may vary depending on the type of cancer. In some cases, even if the primary tumor biopsy is negative, the cancer cells may have spread to nearby lymph nodes. In other cases, the risk of spread may be lower, and lymph node removal may not be necessary.

2. **Stage of Cancer:** The stage of cancer, which indicates the extent of its spread, is crucial in determining the need for lymph node removal. If the cancer is in an early stage and there is a low risk of lymph node involvement, removal may not be recommended. However, in more advanced stages, the risk of spread may be higher, and removal could be considered.

3. **Size and Location of Tumor:** The size and location of the primary tumor also play a role. Larger tumors or those located in certain areas may have a higher likelihood of spreading to nearby lymph nodes.

4. **Patient's Overall Health:** The patient's overall health and ability to tolerate surgery are important factors. Lymph node removal is a surgical procedure that comes with its own risks, and these need to be weighed against the potential benefits.

5. **Imaging Studies:** Advanced imaging studies, such as PET scans or sentinel lymph node mapping, may provide additional information about the potential involvement of lymph nodes. These tests can help guide the decision-making process.

It's crucial to discuss these factors with your healthcare team, including your oncologist and surgeon. They can provide personalized advice based on your specific situation and help you make an informed decision about whether lymph node removal is necessary. Always seek a second opinion if you have concerns or if you want to explore different treatment options.