When Is Lymph Node Biopsy Indicated in Children with Enlarged Peripheral Nodes?

Abstract

To better define the indications for diagnostic biopsy, 239 children who underwent peripheral lymph node biopsy were reviewed. The duration of the lymphadenopathy by history, the consistency of the lymph nodes, and the presence of more than one site of palpable adenopathy were not specific in differentiating serious diseases involving lymph nodes from reactive hyperplasia. The differential diagnosis of specific causes for lymph node enlargement is approached based on the child's age, the location of the adenopathy, and the presence or absence of lymph node fixation and tenderness. Most children with supraclavicular adenopathy, children sick with fever of one week's duration or with weight loss for which a specific diagnosis is not readily made, and some children with fixation of the lymph node to the overlying skin should undergo early biopsy. Excluding the above findings, when a specific diagnosis is not apparent, serial measurements with a ruler over several weeks appears to be the most reasonable method, at the present time, of discriminating hyperplastic lymph nodes from nodes that are involved by a progressive disease process.

Anomalous Articulation of the First Rib Mimicking Supraclavicular Neoplasia

“…In one study supraclavicular adenopathy was positive for malignancy in 60% (14 of 23) of the children. 5 In our patient, the size (3 x 3 cm), location (supraclavicular), and consistency (hard) of the mass was suggestive of a neoplastic process. The left arm paresthesia prompted us to consider a process that was impinging on or invading the brachial plexus.…”

“…However, even in this age group, the presence of an isolated supraclavicular mass should alert the physician to the potential seriousness of this finding. In one study supraclavicular adenopathy was positive for malignancy in 60% (14 of 23) of the children 5…”

“…This practice is especially warranted with masses in the supraclavicular fossa, given their high incidence of primary and metastatic neoplasia 2–4. In children and adolescents, a neck mass most often represents a congenital/developmental lesion, a reactive hyperplasia, or an inflammatory process rather than a neoplasia 5,6. However, even in this age group, the presence of an isolated supraclavicular mass should alert the physician to the potential seriousness of this finding.…”

Association of Clinical, Laboratory and Ultrasound Characteristics With the Etiology of Peripheral Lymphadenopathy in Children

“…The prevalence of malignancy among children with lymphadenopathy managed in the primary care setting is approximately 5%; however, it increases to 13-27% among children who underwent biopsy in pediatric referral centers (12,14,15). The risk of malignancy increases with worrisome features such as systemic (B) symptoms (fever > 1 week, weight loss > 10%, night-time sweating), xed and nontender lymph nodes, lymph nodes > 2 cm in diameter and not responding to antibiotic therapy, unusual locations (e.g., supraclavicular, mediastinal), generalized lymphadenopathy and unexplained abnormal laboratory results such as bicytopenia or pancytopenia, persistently elevated erythrocyte sedimentation rate (ESR) and highly elevated lactate dehydrogenase (LDH) levels (6, 12,16,17).…”

Características clínicas e histopatológicas de las adenopatías en pediatría. Análisis de 10 años en un hospital privado

“…7 En estudios previos se ha descrito que los hallazgos más frecuentes en biopsias ganglionares son: hiperplasia reactiva (52%), enfermedad granulomatosa (36.3%), enfermedad neoplásica (8.2%), dermatosis (3%), o infección bacteriana (3%). 8 En otro estudio, en Costa Rica, al incluir preescolares entre cuatro y ocho años, lo más frecuente fue: hiperplasia reactiva (54%), adenitis bacteriana (19%) y linfadenitis toxoplásmica (13%). 8 Mientras que en Cuba, 79% correspondió a adenitis crónica inespecífica, 7% con hiperplasia linfoide reactiva y sólo un paciente con neoplasia.…”