Paediatric cervical lymphadenopathy: when to biopsy?

• Published in: Current opinion in otolaryngology & head and neck surgery Vol. 21; no. 6; p. 567
• Main Author: Nolder, Abby R
• Format: Journal Article
• Language: English
• Published: United States 01.12.2013
• Subjects: Adolescent; Age Factors; Biopsy; Child; Child, Preschool; Humans; Lymphatic Diseases - etiology; Lymphatic Diseases - pathology; Lymphatic Diseases - therapy; Neck; Patient Selection
• ISSN: 1531-6998
• DOI: 10.1097/MOO.0000000000000003

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. 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. 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.