Cervical lymphadenopathy: study of 251 patients

Abstract

Correct diagnosis of cervical lymphadenopathy is often a great challenge. The objective of this case study is to describe the distribution of the most common causes of unclear neck swellings presented in an ENT-Department and to evaluate the clinical history, examination and laboratory findings. In a retrospective study at the Department of Otorhinolaryngology, University Medical Center Homburg/Saar, 251 patients were enrolled with clinical and ultrasound signs of cervical lymphadenopathy as well as lymph node extirpation for histopathological evaluation. 127 patients (50.6 %) had a histological malignant finding. The distribution of the most common pathological conditions was as follows: Non-specific reactive hyperplasia n = 89 (35.5 %), metastases n = 86 (34.3 %), lymphoma n = 41 (16.3 %), granulomatous lesions n = 15 (6 %), abscess formations n = 5 (2 %), necrotic lymphadenitis and Castleman's disease one case of each, lymph node with normal architecture n = 7 (2.8 %), and neck masses mimicking lymphadenopathy n = 6 cases (2.4 %). The following factors identified by multivariate logistic regression were significantly associated to malignant lymphadenopathy: increasing age, generalized lymphadenopathy and history of malignant disorder, fixed neck masses and increasing diameter in ENT examination, bulky lesion, absence of hilus, blurred outer contour, protective role of the long form and decreasing Solbiati-index values by ultrasound B-Mode gray scale examination. Level II contained more benign lymphatic lesions, while the malignancy rate in level IV and V was enhanced. Laboratory parameters significantly associated to malignancies were CRP, LDH and thrombocytopenia. Patients with persisting cervical lymphadenopathy and over 3 weeks of antibiotic treatment should be considered for early biopsy, especially if some of the risk factors, pointed out in this study, are present.

Predictive factors for malignancy in patients with persistent cervical lymphadenopathy

“…They included 95 patients in a logistic regression analysis for malignancy of a neck mass and found only patient age to be significant. Al Kadah et al [10] analyzed 251 cases of unclear cervical lymphadenopathy and found a statistically significant correlation between increasing age and incidence of malignancy. In a retrospective study, Tsai et al [11] included 166 patients with neck lesions and found that larger size, increased age, supraclavicular location, tumor fixation, tenderness, and tumor size were significant predictors of malignancy.…”

Sonographic differentiation between lymphatic and metastatic diseases in cervical lymphadenopathy

“…It is, therefore, generally agreed upon that biopsies should be obtained in patients presenting with enlarged lymph nodes if there is no sign of a primary tumor and no clinical signs of acute infection . Lymphadenectomy is traditionally considered the gold standard in diagnostic evaluation of cervical lymphadenopathy, especially to rule out lymphomas . Recent guidelines proposed fine‐needle aspiration cytology (FNAC) as an alternative.…”

“…Different clinical and imaging parameters have been proposed in the literature to differentiate between cases in which diagnostic lymph node extirpation is necessary and cases where a watch‐and‐wait strategy is sufficient. Hard texture, hilar vascularization, history of malignancy, older age, large lymph node size, irregular outside contour, lack of lymph node mobility, low Solbiati index, sonographic nonhomogeneity of the lymph node, and supraclavicular localization have been identified as clinical predictors for malignancy …”

“…Hard texture, hilar vascularization, history of malignancy, older age, large lymph node size, irregular outside contour, lack of lymph node mobility, low Solbiati index, sonographic nonhomogeneity of the lymph node, and supraclavicular localization have been identified as clinical predictors for malignancy. [5][6][7] However, there are considerable clinical and sonomorphological differences between the malignant entities. Although lymphoma patients characteristically present with multiple, small hypervascularized lymph nodes, patients with metastases characteristically present with larger solitary nodes and are considerably older than lymphoma patients.…”

From Benign to Malign in a Case of Cervical Adenopathy in a 17-Year-Old Adolescent: Diagnostic Traps

“…Al Kadah et al in 2015 [13] performed a study on 251 patients and found the following statistically significant factors associated with the cervical mass neoplasia: generalised lymphadenopathy, history of malign diseases, adherent cervical mass, immobile, increased diameter, bulky lesions, absence of hilus, irregular external shape, the protective role of the long forms and low Solbiati index values in the ultrasound B mode gray scale examination and laboratory parameters for thrombocytopenia, and high CRP and LDL. The persistence of a cervical adenopathy for more than 3 weeks warrants a biopsy.…”