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Risk factors for malignancy in pediatric subacute/chronic focal craniocervical lymphadenopathy.

Yishai Haimi-Cohen1,2,3, Eyal Elron3,4, Lital Oz-Alcalay5

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In children with persistent neck lymphadenopathy, older age and larger lymph nodes are key indicators of potential malignancy. These factors help guide decisions for surgical intervention in pediatric cases.

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Area of Science:

  • Pediatric Oncology
  • Head and Neck Surgery
  • Diagnostic Imaging

Background:

  • Focal persistent isolated craniocervical lymphadenopathy is common in children.
  • Malignancy risk is generally low, but identifying high-risk cases is crucial for timely intervention.
  • Decisions regarding surgical excision require accurate risk stratification.

Purpose of the Study:

  • To identify factors associated with malignancy in children with focal persistent isolated craniocervical lymphadenopathy.
  • To assist in clinical decision-making regarding nodal surgical excision in pediatric patients.
  • To improve the diagnostic accuracy for malignancy in pediatric neck masses.

Main Methods:

  • Retrospective analysis of demographic and clinical data from children treated between January 2008 and December 2020.
  • Inclusion of children with subacute and chronic craniocervical lymphadenopathy from a tertiary pediatric ambulatory clinic.
  • Univariate and multivariate analyses were performed to assess risk factors for malignancy.

Main Results:

  • Of 450 children, 5.6% were diagnosed with malignancy.
  • Factors associated with malignancy included older age, larger nodal size, specific lymph node locations (supraclavicular, lateral cervical), and systemic symptoms.
  • Multivariate analysis confirmed older age (OR 1.649 per 3 years) and larger lymph nodes (OR 2.080 per cm) as significant predictors of malignancy.

Conclusions:

  • Older age and increased lymph node size are significant indicators of malignancy risk in children with craniocervical lymphadenopathy.
  • These findings support considering surgical intervention for children presenting with these risk factors.
  • Improved identification of high-risk pediatric patients can lead to earlier diagnosis and treatment.