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Paediatric cervical lymphadenopathy: when to biopsy?

Nolder, Abby R.

Current Opinion in Otolaryngology & Head & Neck Surgery:
doi: 10.1097/MOO.0000000000000003
PEDIATRIC OTOLARYNGOLOGY: Edited by Lisa Buckmiller
Abstract

Purpose of review: Cervical lymphadenopathy is common in the paediatric population and persistent lymphadenopathy of unknown cause is a frequent reason for otolaryngology referral. Diagnostic work-up is variable among physicians and deciding when excisional biopsy is necessary remains a challenge. This update reviews the recent literature on the work-up and diagnosis of paediatric cervical lymphadenopathy, with a focus on factors that may influence the need for excisional biopsy.

Recent findings: The majority of paediatric cervical lymphadenopathy cases are benign, with infection and reactive lymphoid hyperplasia being far more common than malignancy. Ultrasound is the initial imaging modality of choice for paediatric cervical lymphadenopathy and can provide critical information to aid in diagnosis. Clinical factors that may predict malignancy include lymph node size greater than 2 cm, multiple levels of adenopathy and supraclavicular location. Biopsy should be strongly considered in patients with a combination of these factors or other suspicious findings such as severe systemic symptoms.

Summary: Paediatric cervical lymphadenopathy is commonly encountered in general and paediatric otolaryngology practice; however, absolute guidelines for biopsy do not exist. Careful consideration of history, physical examination, laboratory work-up and diagnostic imaging must be used to guide the clinician in decision-making for biopsy.

Author Information

Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA

Correspondence to Abby R. Nolder, MD, Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Slot 543, Little Rock, AR 72205, USA. Tel: +1 501 364 1696

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins