Level 5 Lymphadenopathy Warrants Heightened Suspicion for Clinically Significant Pathology

Abstract

We conclude that patients presenting with level 5 lymphadenopathy should be investigated with heightened clinical vigilance. Our results suggest that up to 80 % will harbour clinically significant pathology requiring further medical treatment, three quarters of which will be malignancy. We report an observational study of histological outcomes of level 5 lymph node biopsies from a regional histopathology department across 5 years. 184 subjects were identified as having a biopsy of a lymph node from the level 5 region within the study period. One hundred and fifty six cases (84.8 %) had clinically significant pathology on final histology requiring further medical treatment. Lymphoma accounted for the highest number of cases (n = 72, 39.1 %), followed by metastatic carcinoma (n = 65, 35.3 %) and granulomatous change (n = 17, 9.2 %). Gender and laterality were not shown to be independent predictors of pathology significance (p [ 0.05).

Machine Learning Logistic Regression Model for Early Decision Making in Referral of Children with Cervical Lymphadenopathy Suspected of Lymphoma

“…All variables used in our diagnostic model, besides TARC, have been described previously as separate predicting factors for lymphoma [8,32,33,37,[46][47][48][49][50][51][56][57][58][59][60][61]. Our study confirmed that enlarged mediastinum is an absolute "red flag", calling for prompt referral to the pediatric oncologist.…”

“…We searched for studies using Medical Subject Heading terms including "lymphadenopathy", "child", "adolescent", and "lymphoma". An overview of potential predicting factors based on this search of the literature and their results are given in Table S1 [8,[31][32][33][34][35][36][37][38][46][47][48][49][50][51][52]. We identified 39 potential predictors and included these in our univariate analyses: age, gender, presence of B-symptoms, 11 laboratory parameters including TARC, and several imaging findings.…”

Updates in COVID-19 Related Lymphadenopathy - Frequent Deep Axillary Location and Possible Contralateral Involvement

“…In our case, the patient number 2 had a personal history of breast cancer with positive lymph nodes and presented with suspicious axillary lymphadenopathy (round shape, indistinct margins) and multiple bilateral supraclavicular lymph nodes. Even if the size of supraclavicular nodes was less than 1 cm, the bilateral involvement of this node groups warrants heightened suspicion for clinically significant pathology, with up to 84% of the cases attributed to malignancy [15] . According to all the above mentioned rationale, a BIRADS 4b category and a core needle biopsy from the axillary node was performed.…”

Cervical lymphadenopathy following coronavirus disease 2019 vaccine: clinical characteristics and implications for head and neck cancer services

“… 15 , 16 The differential diagnosis of lymphadenopathy in the lower neck is broad, but it is imperative to exclude pathologies like head and neck malignancy, lymphoma, and metastatic lung or cutaneous cancers. 10 , 15 However, as vaccine deployment is still in its early stages, no data are yet available regarding the presentation, clinical course or imaging characteristics of Covid-19 vaccine associated cervical lymphadenopathy to guide the decision-making process in such patients.…”

“…[12][13][14] As lower neck lymphadenopathy harbours malignancy in around 75 per cent of cases, the UK National Institute for Health and Care Excellence recommended fast-track referral of unexplained or persistent cases through a dedicated pathway for suspected head and neck cancer. 15,16 The differential diagnosis of lymphadenopathy in the lower neck is broad, but it is imperative to exclude pathologies like head and neck malignancy, lymphoma, and metastatic lung or cutaneous cancers. 10,15 However, as vaccine deployment is still in its early stages, no data are yet available regarding the presentation, clinical course or imaging characteristics of Covid-19 vaccine associated cervical lymphadenopathy to guide the decision-making process in such patients.…”