Clinical features and outcomes of lymphadenopathy in a tertiary children's hospital

Abstract

Aim The aim of the present study is to describe the clinical features and outcomes of childhood lymphadenopathy and to define factors able to predict neoplastic aetiology or may improve its prognosis. Methods All children evaluated for lymphadenopathy in our tertiary children's hospital and who underwent their first examination between 1 January, 2015 and 31 December, 2017 were enrolled in this retrospective observational study. Data were analysed using SPSS.Statistics, 24.0. Results A total of 322 children, aged between 0 and 18 years (median 4.5; interquartile range 2.5–9), were enrolled. A specific diagnosis was achieved in almost half of the cases (n = 159, 49.4%) by using one or more methods, including serological, microbiological, biomolecular or histological investigations on surgical samples. Epstein Barr virus and non‐tuberculous mycobacteria were the most common etiological agents among acute/sub‐acute and chronic lymphadenopathy, respectively. At the end of the study period, two‐thirds (210, 65.2%) of enrolled patients were successfully treated. Malignancies and non‐tuberculous mycobacteria infections had the longest time to resolution. Conclusions Our data suggest that lymphadenopathy is a benign condition in most cases. Of note in our study, 2.5% of lymphadenopathy cases were found to be due to oncologic conditions. The most frequent infective causes were Epstein Barr virus, bacteria and non‐tuberculous mycobacteria infections. No haematic or ultrasonographic features were independently able to provide sufficient evidence for a conclusive diagnosis. However, utilising these findings alongside evaluation for clinical criteria can guide decision‐making for physicians. Lymphadenectomy is the most appropriate process to follow in the event of chronic lymphadenopathy with undefined diagnosis.

Lymph node biopsy in children: Indications and etiology

“…The cervical group of nodes was most frequently biopsied in our series, accounting for 64 (92%) cases. Similar findings have been reported by others [8,12] since this area drains the commonest portal of entry of microorganisms. This is also the most conspicuous site and therefore more likely to be noticed by parents and physicians.…”

“…Since our facility is a national referral center for pediatric oncology and pediatric TB, these diagnoses contribute to a disproportionately large percentage in our study population; a similar finding has been reported from other oncological referral centers where malignancy formed a major percentage of cases. [6,7] In contrast, authors from general pediatric facilities report reactive hyperplasia in larger percentages of their patients [8,9], similar results seen in a local study assessing lymph node biopsies in the general pediatric population. [10] The indications for lymph node biopsy are not clearly defined [11] and hence are often based on the assessment of individual clinicians.…”

Acute bacterial lymphadenitis in children: a retrospective, cross-sectional study

“…Lymphadenopathy is a common presentation in childhood occurring in 44% of children between the ages of 0 and 5 years [1]. Acute lymphadenitis (with symptoms of up to 2 weeks of duration) has a broad differential diagnosis including pyogenic bacterial infections, poly-or mono-microbial anaerobic infections in association with dental or periodontal disease, Bartonella henselae and Toxoplasmosis as well as viral infections such as Epstein-Barr virus and cytomegalovirus [2].…”

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

“…Lymphadenopathy is a common clinical finding in children and adolescents and can occur at any age [1][2][3][4][5][6][7]. In most cases it is caused by non-malignant conditions, such 2 of 20 as infectious diseases, and therefore requires an empiric approach [8][9][10][11][12]. However, it can be a manifestation of malignancy, in particular lymphoma [13].…”

“…Currently, the only existing guidelines on when to perform a biopsy are ambiguous and the current available literature is inconsistent about prediction factors for lymphoma in children with lymphadenopathy [27][28][29][30]. There are several factors associated with malignant lymphoma in univariate analysis, for example supraclavicular masses [31][32][33], lymph node size [32,34,35], mediastinal enlargement [32,33,35], elevated lactate dehydrogenase (LD) [8,32,35,36], and generalized disease [32,33]. There are only a few studies which were able to perform multivariate analysis, but none of these were sufficiently discriminative for application in clinical practice [31,34,37].…”