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When does an enlarged cervical lymph node in a child need excision? A systematic review
Richard Locke1, Rachael Comfort1, Haytham Kubba1
1Department of Paediatric Otolaryngology, Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, Scotland, United Kingdom.
International Journal of Pediatric Otorhinolaryngology
|January 23, 2014
Summary
Diagnosing pediatric cervical lymphadenopathy requires careful evaluation. While large or supraclavicular nodes warrant biopsy, ultrasound shows promise, and fine needle aspiration cytology (FNAC) is unreliable for excluding malignancy.
Area of Science:
- Pediatric Oncology
- Diagnostic Imaging
- Head and Neck Surgery
Background:
- Palpable cervical lymphadenopathy is common in children, necessitating differentiation between malignancy and benign causes.
- Open biopsy, while diagnostic, carries complication risks and often reveals benign conditions like reactive hyperplasia.
Purpose of the Study:
- To evaluate the diagnostic accuracy of clinical exams and investigations for pediatric cervical lymphadenopathy.
- To minimize the need for open biopsies by identifying reliable non-invasive diagnostic tools.
Main Methods:
- A systematic literature review was conducted using major medical databases (Medline, Embase, CINAHL, Cochrane).
- References from standard pediatric ENT and head and neck textbooks were also examined.
Main Results:
- Evidence for malignancy predictors is weak; large and supraclavicular nodes are concerning.
- Ultrasound shows potential for differentiating benign from malignant nodes, but requires further pediatric studies.
- Fine needle aspiration cytology (FNAC) has variable sensitivity and cannot reliably exclude malignancy.
Conclusions:
- Biopsy is recommended for large and supraclavicular lymph nodes.
- Ultrasound shows promise but needs more research in pediatric cases.
- Current evidence does not support using FNAC to rule out malignancy in children; further research on predictive models is needed.
