Etiologies of Pediatric Cervical Lymphadenopathy: A Systematic Review of 2687 Subjects

Abstract

Background. Cervical lymphadenopathy in children is common and its etiologies diverse. No systematic review of the differential diagnosis of pediatric cervical lymphadenopathy has been conducted. Objective. To determine the prevalence rate of specific etiologies of pediatric cervical lymphadenopathy. Data Sources. EMBASE, PubMed, and SCOPUS were searched electronically. Bibliographies of select studies were reviewed as well. Study Selection. (1) Any clinical trial, observational study, or cross-sectional case series with 10 or more subjects that included delineation of etiologies and/or associated conditions with lymphadenopathy; (2) subjects aged 0 to 21 years with enlarged lymphoid tissue on body; (3) lymphadenopathy was confirmed by clinical evaluation; and (4) no specific diagnoses were excluded. Data Extraction. Year and location of publication, definition of lymphadenopathy, percentage of lymphadenopathy that was cervical, total number of subjects, gender distribution of subjects, age range of patients, and specific etiologies. Results. Of the 1790 studies, 7 studies that were combined resulted in 2687 subjects that were selected. Nonspecific benign etiology was the most common diagnosis occurring at a rate of 67.8%. Epstein-Barr virus was the next most prevalent (8.86%), followed by malignancy (4.69%) and granulomatous disease (4.06%). The most common malignancy etiology was non-Hodgkin’s lymphoma (46.0%), and the most common granulomatous disease was tuberculosis (73.4%). Conclusions. This systematic review and meta-analysis provides a rate-based differential diagnosis of pediatric cervical lymphadenopathy. Although the most common causes of pediatric cervical lymphadenopathy are nonspecific, the etiologies are diverse. Rates and credible intervals are provided to enable a probability-based diagnostic approach to palpable cervical lymphadenopathy in this age group.

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

“…This rate is comparable with literature data. [11][12][13] However, in other cohorts, malignancy rates are higher. 14,15 Where studies were conducted in haematology/oncology units, it is possible that the reported increase in malignancy rate could be attributed to a selection bias.…”

An approach to cervical lymphadenopathy in children

“…(2) In a systematic review of paediatric cervical lymphadenopathy involving 2,687 patients, two thirds of the cases were due to non-specific benign aetiology with no definitive diagnosis, and 4.7% were secondary to malignancy. (3) When first reviewing a child with cervical lymphadenopathy, the primary care physician is faced with a conundrum -manage at primary care or refer for specialist review? We propose that the physician's familiarity with the differential diagnoses of lymphadenopathy and neck masses increases the success rate of managing this in primary care.…”

“…Serena Su Ying Chang 1 , MMed, MRCPCH, Mengfei Xiong 2 , MBBS, Choon How How 3,4 , MMed, FCFP, Dawn Meijuan Lee 1 , MBBS, MRCPCH…”

Linfadenopatía cervical en pediatría

“…La linfadenitis bacteriana se desarrolla con mayor frecuencia en regiones submandibulares (50-60%) o cervicales superiores (25-30%). 4 Hasta 25% de los pacientes con linfadenitis bacteriana aguda demostrará fl uctuación en el examen físico, y esto es especialmente cierto con la linfadenitis por Staphylococcus aureus. 1,2,8,9 Entre los hallazgos que pueden sugerir malignidad se incluyen ganglios que se agrandan rápidamente, fi rmes, no sensibles y fi jados a la piel o estructuras subyacentes.…”

“…El linfoma no Hodgkin fue la etiología maligna más frecuente (46% de las neoplasias malignas), mientras que la tuberculosis fue la enfermedad granulomatosa más frecuente (73.4% de los casos de origen granulomatoso). 4,5 En un estudio realizado en el Departamento de Pediatría de la Universidad «Luigi Vanvitelli» en Nápoles, Italia durante un periodo de 15 años (de enero de 2003 a diciembre de 2017), con un total de 392 casos, 56.1% tenían antecedentes de infección, 16.8% fueron diagnosticados de neoplasia y 24.9% casos con diagnóstico de cambios infl amatorios reactivos de origen inespecífi co. Concluyendo que las infecciones agudas son la causa más común de linfadenopatía de cabeza y cuello en la población pediátrica, en su mayoría benignas y autolimitadas. 6 Abordaje: una historia clínica completa, con adecuado interrogatorio y examen físico es fundamental para un diagnóstico preciso:…”