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Nofi CP, Roberts BK, Kallis MP, Koo D, Glick RD, Rich BS. Management of Persistent Low-Suspicion Cervical Lymphadenopathy in Pediatric Patients. J Surg Res 2024; 298:71-80. [PMID: 38581765 DOI: 10.1016/j.jss.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/25/2024] [Accepted: 03/12/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION Cervical lymphadenopathy in children is typically self-limited; however, the management of persistent lymphadenopathy remains unclear. This study aimed to evaluate the management and outcomes of patients with persistent cervical lymphadenopathy. METHODS Single-institution, retrospective review of children <18 years undergoing ultrasound (US) for cervical lymphadenopathy from 2013 to 2021 was performed. Patients were stratified into initial biopsy, delayed biopsy, or no biopsy groups. Clinical characteristics and workup were compared, and multivariate analyses were performed to assess predictors of delayed biopsy. RESULTS 568 patients were identified, with 493 patients having no biopsy, 41 patients undergoing initial biopsy, and 34 patients undergoing delayed biopsy. Presenting symptoms differed: no biopsy patients were younger, were more likely to present to the emergency department, and had clinical findings often associated with acute illness. Patients with USs revealing abnormal vascularity or atypical architecture were more likely to be biopsied. History of malignancy, symptoms >1 week but <3 months, and atypical or change in architecture on US was associated with delayed biopsy. Patients with long-term follow-up (LTF) were followed for a median of 99.0 days. Malignancies were identified in 12 patients (2.1%). All malignancies were diagnosed within 14 days of presentation, and no malignancies were identified in LTF. CONCLUSIONS Patients with persistent low suspicion lymphadenopathy are often followed for long durations; however, in this cohort, no malignancies were diagnosed during LTF. We propose an algorithm of forgoing a biopsy and employing primary care surveillance and education, which may be appropriate for these patients in the proper setting.
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Affiliation(s)
- Colleen P Nofi
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell, Hempstead, New York; Division of Pediatric Surgery, Cohen Children's Medical Center at Hofstra/Northwell, Queens, New York
| | - Bailey K Roberts
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell, Hempstead, New York; Division of Pediatric Surgery, Cohen Children's Medical Center at Hofstra/Northwell, Queens, New York
| | - Michelle P Kallis
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell, Hempstead, New York; Division of Pediatric Surgery, Cohen Children's Medical Center at Hofstra/Northwell, Queens, New York
| | - Donna Koo
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell, Hempstead, New York
| | - Richard D Glick
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell, Hempstead, New York; Division of Pediatric Surgery, Cohen Children's Medical Center at Hofstra/Northwell, Queens, New York
| | - Barrie S Rich
- Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell, Hempstead, New York; Division of Pediatric Surgery, Cohen Children's Medical Center at Hofstra/Northwell, Queens, New York.
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Ruffle A, Beattie G, Prasai A, Jeanes A, Paddock M. Fifteen-minute consultation: A structured approach to the child with palpable cervical lymph nodes. Arch Dis Child Educ Pract Ed 2023; 108:326-329. [PMID: 35177487 DOI: 10.1136/archdischild-2020-321378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/31/2022] [Indexed: 11/04/2022]
Abstract
Palpable cervical lymph nodes are common in children and are a frequent reason for presentation to both primary and secondary care. Enlarged lymph nodes are most commonly the result of self-limiting infection, and in children, are rarely the first indicator of a malignant process. This article presents an evidenced-based approach to evaluating these patients.
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Affiliation(s)
- Amy Ruffle
- Department of Oncology, Leeds Children's Hospital, Leeds, UK
| | - George Beattie
- Emergency Department, Barnsley Hospital NHS Foundation Trust, Barnsley, UK
| | - Amit Prasai
- Ear, Nose & Throat Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Annmarie Jeanes
- Department of Radiology, Leeds Children's Hospital, Leeds, UK
| | - Michael Paddock
- Medical Imaging Department, Barnsley Hospital NHS Foundation Trust, Barnsley, UK
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
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Elgendy A, Elhawary E, Shareef MM, Romeih M, Ebeed A. Ultrasound Elastography in the Diagnosis of Malignant Cervical Lymphadenopathy in Children: Can It Replace Surgical Biopsy? Eur J Pediatr Surg 2022; 32:321-326. [PMID: 34091882 DOI: 10.1055/s-0041-1729900] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION We aimed to assess the accuracy of ultrasound elastography in detecting pediatric malignant cervical lymph nodes, and if this modality can obviate the need for surgical biopsies. MATERIAL AND METHODS A prospective study from September 2017 to September 2020 included 64 children with persistent cervical lymphadenopathy. Patients were evaluated by meticulous history and physical assessment. B-mode ultrasound, color Doppler, and sonoelastography were conducted thereafter. Elastography scans were classified into five patterns, and patterns from 3 to 5 were considered as malignancies. All children underwent open biopsies followed by pathological examination. Results of tissue diagnosis were compared with patterns of elastography to determine its accuracy. RESULTS Twenty-eight patients (43.8%) had malignant nodes and the remaining 36 (56.2%) were due to benign causes. Elastography patterns of 1 and 2 were documented in 30 patients, and all of them were diagnosed as benign lesions. Patterns of 3 to 5 were demonstrated in 34 patients. Out of them, 28 were confirmed as malignancies, while 6 children were of benign nature (false positive). Ultrasound elastography achieved sensitivity and specificity of 100 and 85.7%, respectively, and an overall accuracy of 90.6% in the differentiation between malignant and benign entities. The overall accuracy of B-mode and color Doppler were 75 and 82.2%, respectively. CONCLUSION Elastography is a useful tool that should be added to ultrasound modalities during the diagnosis of pediatric cervical lymphadenopathy. Surgical biopsy in eligible patients is imperative to commence proper therapy or to discharge the child. Despite favorable results of elastography, it cannot replace surgical biopsy or change its indications.
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Affiliation(s)
- Ahmed Elgendy
- Surgical Oncology Unit, Department of Surgery, Tanta University, Tanta, Egypt
| | - Eslam Elhawary
- Pediatric Hematology/Oncology and Bone Marrow Transplantation Unit, Department of Pediatrics, Tanta University, Tanta, Egypt
| | | | - Marwa Romeih
- Department of Radiology, Helwan University, Cairo, Egypt
| | - Ahmed Ebeed
- Department of Radiology, Kafrelsheikh University, Kafrelsheikh, Egypt
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Cahalane AM, Kilcoyne A, Tabari A, McDermott S, Gee MS. Computed tomography texture features can discriminate benign from malignant lymphadenopathy in pediatric patients: a preliminary study. Pediatr Radiol 2019; 49:737-745. [PMID: 30741316 DOI: 10.1007/s00247-019-04350-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 11/26/2018] [Accepted: 01/24/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Differentiation of benign from malignant lymphadenopathy remains challenging in pediatric radiology. Textural analysis (TA) quantitates heterogeneity of tissue signal intensities and has been applied to analysis of CT images. OBJECTIVE The purpose of this study was to establish whether CT textural analysis of enlarged lymph nodes visualized on pediatric CT can distinguish benign from malignant lymphadenopathy. MATERIALS AND METHODS We retrospectively identified enlarged lymph nodes measuring 10-20 mm on contrast-enhanced CTs of patients age 18 years and younger that had been categorized as benign or malignant based on the known diagnoses. We placed regions of interest (ROIs) over lymph nodes of interest and performed textural analysis with and without feature size filtration. We then calculated test performance characteristics for TA features, along with multivariate logistic regression modeling using Akaike Information Criterion (AIC) minimization, to determine the optimal thresholds for distinguishing benign from malignant lymphadenopathy. RESULTS We identified 34 enlarged malignant nodes and 29 benign nodes from 63 patients within the 10- to 20-mm size range. Filtered image TA exhibited 82.4% sensitivity, 86.2% specificity and 84.1% accuracy for detecting malignant lymph nodes using mean and entropy parameters, whereas unfiltered TA exhibited 88.2% sensitivity, 72.4% specificity and 81.0% accuracy using mean and mean value of positive pixels parameters. CONCLUSION This preliminary study demonstrates that the use of TA features improves the utility of pediatric CT to distinguish benign from malignant lymphadenopathy. The addition of TA to pediatric CT protocols has great potential to aid the characterization of indeterminate lymph nodes. If definitive differentiation between benign and malignant lymphadenopathy is possible by TA, it has the potential to reduce the need for follow-up imaging and tissue sampling, with reduced associated radiation exposure. However future studies are needed to confirm the clinical applicability of TA in distinguishing benign from malignant lymphadenopathy.
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Affiliation(s)
- Alexis M Cahalane
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA.
| | - Aoife Kilcoyne
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA
| | - Azadeh Tabari
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA
| | - Shaunagh McDermott
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA
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Lilja-Fischer JK, Schrøder H, Nielsen VE. Pediatric malignancies presenting in the head and neck. Int J Pediatr Otorhinolaryngol 2019; 118:36-41. [PMID: 30578994 DOI: 10.1016/j.ijporl.2018.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/05/2018] [Accepted: 12/06/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Childhood cancer is rare and often difficult to diagnose. In the head and neck region, benign diseases are much more common. The aim of this study was to estimate the proportion of childhood cancer cases with a primary head and neck presentation, to describe symptoms, physical findings, diagnostic interval and tentative diagnoses. METHODS Registry-based retrospective cohort study, with patients identified in the Danish Childhood Cancer Registry. Review of medical records, imaging reports and pathology reports. All childhood cancer patients less than 15 years of age with primary disease presentation in the head and neck region from the Central Danish Region in the years 2003-2013. Outcome measures were proportion of patients with a primary head and neck presentation; frequency of physical findings; diagnostic intervals; and frequency of tentative diagnoses. RESULTS 85 patients (15% of all childhood cancers) had primary disease presentation in the head & neck region (95% confidence interval [CI]: 12 - 18%). A total of 24% (CI: 21 - 28%) of patients had any symptoms or findings from the head and neck region at presentation. Most common symptoms and findings were a swelling or a tumor, and possibly general symptoms. Diagnostic interval was more than three weeks in three out of four of patients. Primary suspicion was most commonly an infectious disease. CONCLUSIONS A substantial proportion of patients with childhood cancer have disease presentation in the head and neck. Worth noting is, that symptoms and findings are easily mistaken for an infectious disease, which probably explains the significant diagnostic interval.
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Affiliation(s)
- Jacob Kinggaard Lilja-Fischer
- Department of Otorhinolaryngology - Head & Neck Surgery, Aarhus University Hospital, Denmark; Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark.
| | - Henrik Schrøder
- Paediatrics and Adolescent Medicine, Aarhus University Hospital, Denmark
| | - Viveque E Nielsen
- Department of Otorhinolaryngology - Head & Neck Surgery, Odense University Hospital, Denmark
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Lindeboom JA, Schreuder WH. Similar presentation of cervical lymphadenitis of different etiology in two siblings. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 122:e51-4. [PMID: 27422429 DOI: 10.1016/j.oooo.2016.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/13/2016] [Accepted: 04/18/2016] [Indexed: 12/20/2022]
Abstract
Here, we report chronic suppurating submandibular swelling occurring in two siblings, with one case caused by nontuberculous mycobacteria and the other caused by Bartonella henselae. These two infections share a similar clinical presentation, but the treatment modalities differed.
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Affiliation(s)
- Jerome A Lindeboom
- Department of Oral and Maxillofacial Surgery, Amstelland Hospital, Amstelveen, The Netherlands.
| | - Willem H Schreuder
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
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