Lymphadenopathy in children: A streamlined approach for the surgeon — A report from the APSA Cancer Committee

Grant, Christa N.; Aldrink, Jennifer H.; Lautz, Timothy B.; Tracy, Elisabeth T.; Rhee, Daniel S.; Baertschiger, Reto M.; Dasgupta, Roshni; Ehrlich, Peter F.; Rodeberg, David A.

doi:10.1016/j.jpedsurg.2020.09.058

Cited by 20 publications

(16 citation statements)

References 56 publications

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“…4,26 Surgical biopsy, especially with an intact capsule, is considered the procedure of choice to get sufficient tissue material for precise pathological and immunohistochemical assessment. 3,5 The authors of this study adopted excisional biopsy as a standard approach for children who had persistent cervical nodes with unconfirmed diagnoses in agreement with others. 5,26,27 Other studies, however, depended on FNAC for pathological diagnosis and they declared that such adjunct was accurate and successful.…”

Section: Discussionsupporting

confidence: 80%

“…2 Thus, exclusion of malignancy by pediatricians and pediatric surgeons is sometimes imperative and might be a challenge. 3 The initial assessment of those children includes a detailed history and a careful physical examination. Furthermore, certain laboratory investigations and radiological evaluation should be conducted for unexplained etiology.…”

Section: Introductionmentioning

confidence: 99%

“…2 Thus, exclusion of malignancy by pediatricians and pediatric surgeons is sometimes imperative and might be a challenge. 3…”

Section: Introductionmentioning

confidence: 99%

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Ultrasound Elastography in the Diagnosis of Malignant Cervical Lymphadenopathy in Children: Can It Replace Surgical Biopsy?

et al. 2021

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Introduction We aimed to assess the accuracy of ultrasound elastography in detecting pediatric malignant cervical lymph nodes, and if this modality can obviate the need for surgical biopsies. Material and Methods A prospective study from September 2017 to September 2020 included 64 children with persistent cervical lymphadenopathy. Patients were evaluated by meticulous history and physical assessment. B-mode ultrasound, color Doppler, and sonoelastography were conducted thereafter. Elastography scans were classified into five patterns, and patterns from 3 to 5 were considered as malignancies. All children underwent open biopsies followed by pathological examination. Results of tissue diagnosis were compared with patterns of elastography to determine its accuracy. Results Twenty-eight patients (43.8%) had malignant nodes and the remaining 36 (56.2%) were due to benign causes. Elastography patterns of 1 and 2 were documented in 30 patients, and all of them were diagnosed as benign lesions. Patterns of 3 to 5 were demonstrated in 34 patients. Out of them, 28 were confirmed as malignancies, while 6 children were of benign nature (false positive). Ultrasound elastography achieved sensitivity and specificity of 100 and 85.7%, respectively, and an overall accuracy of 90.6% in the differentiation between malignant and benign entities. The overall accuracy of B-mode and color Doppler were 75 and 82.2%, respectively. Conclusion Elastography is a useful tool that should be added to ultrasound modalities during the diagnosis of pediatric cervical lymphadenopathy. Surgical biopsy in eligible patients is imperative to commence proper therapy or to discharge the child. Despite favorable results of elastography, it cannot replace surgical biopsy or change its indications.

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Section: Discussionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

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Ultrasound Elastography in the Diagnosis of Malignant Cervical Lymphadenopathy in Children: Can It Replace Surgical Biopsy?

et al. 2021

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“…Multiple studies have aimed to describe clinical and radiographic features of lymphadenopathy that warrant surgical intervention. 15,16 Prior studies have suggested that the size of the node increases the suspicion of malignancy with greater than 3 cm as raising concern. 11 Our study suggests that size alone should not be a determinant for surgical intervention without other associated concerning features and that even larger, otherwise asymptomatic nodes can be monitored, and are likely to shrink with time.…”

Section: Ultrasound Characteristics and Utilizationmentioning

confidence: 99%

Management of Pediatric Persistent Asymptomatic Cervical Lymphadenopathy

Harris

Patel

Wai

et al. 2023

Otolaryngol.--head neck surg.

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ObjectivePersistent asymptomatic cervical lymphadenopathy (PACL) is a common outpatient referral diagnosis for pediatric otolaryngologists. Historically, excisional biopsy under general anesthesia has been the gold standard for diagnosis but is associated with some risks. Current literature provides little guidance on less invasive monitoring. Our hypothesis is that the majority of children who present with PACL can be safely monitored with ultrasound and avoid the risks of excisional biopsy.Study DesignA retrospective review was performed of patients <18 years of age, referred to a tertiary care children's hospital for PACL who also underwent at least 1 neck ultrasound from 2007 to 2021. Patients with acute neck infections, congenital masses, or known rheumatologic, immunologic, or malignant conditions were excluded. A multivariate logistic regression model was used to determine patient and nodal factors associated with the decision for operative management.SettingUniversity of California, San Francisco Pediatric Otolaryngology Department.ResultsAmong the 197 patients meeting inclusion criteria, 30 (15.2%) underwent surgical biopsy. Overall, 26% underwent repeat ultrasound with a mean interval of 6.6 months, and a mean decrease in nodal size of 0.34 cm. Of the 30 surgical cases, 27 (90%) patients had benign pathology. Multivariate regression analysis revealed pain (p = .04), firmness (p < .001), and lack of a normal fatty hilum on ultrasound (p = .04) as statistically significantly correlated with decisions for surgical management.ConclusionThe majority of pediatric PACL is benign and does not require an excisional biopsy to rule out lymphoma. Serial clinical follow‐up with neck ultrasound can be used to safely monitor patients.

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“…Lymph nodes in children are usually and physiologically bigger than in adolescents and adults; this happens because of the continuous exposure to new antigens [7][8][9][10]. The enlargement of lymph nodes caused by inflammatory and infectious processes is called lymphadenitis [7].…”

Section: Introductionmentioning

confidence: 99%

Management of Infectious Lymphadenitis in Children

et al. 2021

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Lymphadenopathy is an irregularity in the size and texture of the lymph nodes, which is quite common in childhood. When the enlargement of lymph nodes is caused by inflammatory and infectious processes, it is called lymphadenitis. The main objective of this manuscript is to summarize the common infectious etiologies and presentations of lymphadenitis in children providing a management guide for clinical practice. PubMed was used to search for all of the studies published up to April 2021 using keywords such as “lymphadenitis” and “children”. Literature analysis showed that the differential diagnosis for lymphadenitis in pediatrics is broad. Although lymph node enlargement in children is usually benign and self-limited, it is important to exclude malignant etiology. In most cases, history and physical examination allow to identify the correct diagnosis and start a proper treatment with a prompt resolution of the lymphadenopathy. However, particularly in the case of persistent lymphadenitis, determining the cause of lymph node enlargement may be difficult, and the exact etiology may not be identified despite extensive investigations. Further studies should develop and validate an algorithm to assist pediatricians in the diagnosis and timely treatment of lymphadenitis, suggesting situations in which a watchful waiting may be considered a safe approach, those in which empiric antibiotic therapy should be administered, and those requiring a timely diagnostic work-up.

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Lymphadenopathy in children: A streamlined approach for the surgeon — A report from the APSA Cancer Committee

Cited by 20 publications

References 56 publications

Ultrasound Elastography in the Diagnosis of Malignant Cervical Lymphadenopathy in Children: Can It Replace Surgical Biopsy?

Ultrasound Elastography in the Diagnosis of Malignant Cervical Lymphadenopathy in Children: Can It Replace Surgical Biopsy?

Management of Pediatric Persistent Asymptomatic Cervical Lymphadenopathy

Management of Infectious Lymphadenitis in Children

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