Abstract
Background: Lymphadenopathy in children is often a diagnostic challenge for clinicians. It may be one symptom of many diseases including granulomatous diseases and malignancy. The cervical region is a commonly involved area in peripheral lymphadenopathy. Surgical biopsy often provides a definitive diagnosis but occasionally unnecessary in some cases.
Objectives: The objective was to describe children with cervical lymphadenopathy who underwent surgical biopsies and to determine clinical factors that can predict the likelihood of lymph nodes needing further management (LNFM) including granulomatous and malignant lymph nodes. Methods: Data of 87 children with cervical lymphadenopathy undergoing surgical biopsy were retrospectively reviewed. Descriptive study was conducted. Receiver operating characteristic analysis was performed to find out the size of the lymph node suggesting LNFM. Logistic regression was applied to determine independent predictors of LNFM, granulomatous lymph node, and malignant lymph node.
Results: On final diagnosis, 37 lesions (42.53%) were non-LNFM, 36 lesions (41.38%) were granulomatous lymph node, and 14 lesions (16.09%) were malignant lymph node. The ROC analysis showed that size of the lymph node threshold that maximizing sensitivity and specificity was 2 cm to predict LNFM group. Multivariate logistic regression model indicated that submandibular location (OR, 11.86; 95% CI, 2.54-55.38; p-value = 0.002) and abnormal CXR (OR, 20.72; 95% CI, 2.13-201.49; p-value = 0.009) were significant independent predictors of LNFM. Further subgroup analysis demonstrated that overlying skin redness (OR, 8.03; 95% CI, 1.10-58.76; p-value = 0.040) and submandibular location (OR, 9.65; 95% CI, 1.29-72.12; p-value = 0.027) were significant independent predictors of granulomatous lymph node. However, there was no significant predictors for malignant lymph nodes.
Conclusions: Submandibular location and abnormal CXR are important predictors for LNFM. Lymph nodes greater than 2 cm are likely to be LNFM. Overlying skin redness and submandibular location are indicators for granulomatous pathology. The majority of supraclavicular nodes were LNFM, with a high frequency of malignancy, highlighting the need for heightened attention to this site. These data are helpful to supplement clinical judgment before biopsy for clinically diagnosed cervical lymphadenopathy.
DOI
10.56808/2673-060X.5505
Recommended Citation
Achatsachat, Pornchai; Srisan, Nimmita; Rajatapiti, Prapapan; Decharun, Katawaetee; Reukvibunsi, Somboon; and Vejchapipat, Paisarn
(2025)
"Clinical factors predicting the need for biopsy in children with cervical lymphadenopathy,"
Chulalongkorn Medical Journal: Vol. 69:
Iss.
3, Article 1.
DOI: https://doi.org/10.56808/2673-060X.5505
Available at:
https://digital.car.chula.ac.th/clmjournal/vol69/iss3/1