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Xu Y, Chu C, Wang Q, Xiang L, Lu M, Yan W, Huang L. Using T2-weighted magnetic resonance imaging-derived radiomics to classify cervical lymphadenopathy in children. Pediatr Radiol 2024; 54:1302-1314. [PMID: 38937304 PMCID: PMC11255022 DOI: 10.1007/s00247-024-05954-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 05/14/2024] [Accepted: 05/14/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Cervical lymphadenopathy is common in children and has diverse causes varying from benign to malignant, their similar manifestations making differential diagnosis difficult. OBJECTIVE This study aimed to investigate whether radiomic models using conventional magnetic resonance imaging (MRI) could classify pediatric cervical lymphadenopathy. METHODS A total of 419 cervical lymph nodes from 146 patients, and encompassing four common etiologies (Kikuchi disease, reactive hyperplasia, suppurative lymphadenitis and malignancy), were randomly divided into training and testing sets in a ratio of 7:3. For each lymph node, 1,218 features were extracted from T2-weighted images. Then, the least absolute shrinkage and selection operator (LASSO) models were used to select the most relevant ones. Two models were built using a support vector machine classifier, one was to classify benign and malignant lymph nodes and the other further distinguished four different diseases. The performance was assessed by receiver operating characteristic curves and decision curve analysis. RESULTS By LASSO, 20 features were selected to construct a model to distinguish benign and malignant lymph nodes, which achieved an area under the curve (AUC) of 0.89 and 0.80 in the training and testing sets, respectively. Sixteen features were selected to construct a model to distinguish four different cervical lymphadenopathies. For each etiology, Kikuchi disease, reactive hyperplasia, suppurative lymphadenitis, and malignancy, an AUC of 0.97, 0.91, 0.88, and 0.87 was achieved in the training set, and an AUC of 0.96, 0.80, 0.82, and 0.82 was achieved in the testing set, respectively. CONCLUSION MRI-derived radiomic analysis provides a promising non-invasive approach for distinguishing causes of cervical lymphadenopathy in children.
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Affiliation(s)
- Yanwen Xu
- Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Caiting Chu
- Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qun Wang
- Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Linjuan Xiang
- Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Meina Lu
- Department of Infectious Diseases, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333 Binsheng Road, Hangzhou, 310003, Zhejiang, China
| | - Weihui Yan
- Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lisu Huang
- Department of Infectious Diseases, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333 Binsheng Road, Hangzhou, 310003, Zhejiang, China.
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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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Su WH, Wu CC, Chou CM, Huang SY, Chen HC. Back to the basics-risk factor identification of pediatric malignant lymphadenopathy proven by pathological studies. Pediatr Neonatol 2024; 65:255-259. [PMID: 37980275 DOI: 10.1016/j.pedneo.2023.05.008] [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: 02/20/2023] [Revised: 04/11/2023] [Accepted: 05/25/2023] [Indexed: 11/20/2023] Open
Abstract
PURPOSE Lymphadenopathy (LAP) is a common problem in the pediatric patient. History, physical examinations (PE), ultrasounds, and blood tests were often obtained while studying such lesions. Malignancy should be highly suspected in certain conditions. This study evaluates the relationship between malignant LAP and risk factors for pediatric patients. MATERIALS AND METHODS Medical records of matched patients are reviewed, and data are retrospectively collected. History, PE findings, laboratory data, ultrasound findings, and pathological findings were recorded and analyzed. The median values (interquartile range, IQR) were expressed for continuous variables, and the number of patients (percentage) for categorical variables. Comparisons between groups were performed using the Mann-Whitney U test and the chi-squared test. The significance was set as p value < 0.05. RESULTS A total of 142 pediatric patients underwent a biopsy in our department for LAP from July 2004 to August 2021. Among them, 108 (76.1 %) patients had benign lesions, and 34 (23.9 %) had malignancies. Weight loss, fixed LAP, firm consistency, and serum lactate dehydrogenase (LDH) exceeding 240 U/L were more related to malignant LAP than other risk factors. Multiple regression analysis revealed two independent risk factors. The receiver operating characteristic curve regarding LDH level predicting malignancy revealed a sensitivity of 79.31 % and specificity of 36.51 % by applying the criterion as 230 U/L. CONCLUSIONS For pediatric LAP, history-taking and physical examinations remained the most important approaches. Ultrasounds, serum LDH, and other laboratory studies may only provide clues. The cutoff level of LDH revealed low sensitivity and specificity for malignant LAP. With firm LAP, which is fixed, a biopsy for tissue proof should be performed.
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Affiliation(s)
- Wei-Hsiang Su
- Department of Surgery, Taichung Veterans General Hospital, Taichung, 407219, Taiwan
| | - Cheng-Che Wu
- Department of Surgery, Taichung Veterans General Hospital, Taichung, 407219, Taiwan
| | - Chia-Man Chou
- Division of Pediatric Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, 407219, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, 112304, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, 402202, Taiwan
| | - Sheng-Yang Huang
- Division of Pediatric Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, 407219, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, 112304, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, 402202, Taiwan.
| | - Hou-Chuan Chen
- Division of Pediatric Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, 407219, Taiwan
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Oz Alcalay L, Fanous E, Goldberg L, Livni G, Pasternak Y. Risk Factors for Invasive Interventions in Hospitalized Children With Suppurative Cervical Lymphadenitis. Clin Pediatr (Phila) 2024:99228231222702. [PMID: 38174715 DOI: 10.1177/00099228231222702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Suppurative cervical lymphadenitis sometimes resolves with oral antibiotic treatment; however, many children are hospitalized for intravenous treatment due to lack of improvement. When there is no substantial improvement, the possibility of a liquefaction process is considered, and as a result, source control such as needle aspiration or open surgical drainage is recommended. We examined, among pediatric patients hospitalized with suppurative cervical lymphadenitis, clinical and laboratory predictors for invasive intervention that may lead to early imaging and intervention, hasten recovery, and shorten length of hospitalization. We compared laboratory and clinical characteristics of pediatric patients hospitalized with suppurative cervical lymphadenitis during 2010-2017, according to 3 treatments: needle aspiration (N = 54), open surgical drainage (N = 37), and conservative adequate antibiotic treatment only (N = 292). Physical indicators such as local erythema and fluctuation were found as predictors for invasive interventions in hospitalized pediatric patients diagnosed with suppurative cervical lymphadenitis. No significant associations were found between invasive interventions and laboratory parameters assessed in this study. Children who underwent interventions displayed a prolonged average length of hospitalization and received extended antibiotic treatment prior to hospital admission. In hospitalized pediatric patients diagnosed with suppurative cervical lymphadenitis, physical examination findings are the main predictive factors for invasive interventions. Consequently, when such straightforward clinical findings are observed in the context of insufficient improvement during antibiotic treatment, they should prompt consideration of invasive intervention.
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Affiliation(s)
- Lital Oz Alcalay
- Department of Pediatrics A, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eliana Fanous
- Department of Pediatrics A, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Lotem Goldberg
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Gilat Livni
- Department of Pediatrics A, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Infectious Disease Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Yehonatan Pasternak
- Department of Pediatrics A, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Harris JE, Patel NN, Wai K, Rosbe KW. Management of Pediatric Persistent Asymptomatic Cervical Lymphadenopathy. Otolaryngol Head Neck Surg 2024; 170:69-75. [PMID: 37418178 DOI: 10.1002/ohn.420] [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: 12/29/2022] [Revised: 12/29/2022] [Accepted: 06/17/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE Persistent asymptomatic cervical lymphadenopathy (PACL) is a common outpatient referral diagnosis for pediatric otolaryngologists. Historically, excisional biopsy under general anesthesia has been the gold standard for diagnosis but is associated with some risks. Current literature provides little guidance on less invasive monitoring. Our hypothesis is that the majority of children who present with PACL can be safely monitored with ultrasound and avoid the risks of excisional biopsy. STUDY DESIGN A retrospective review was performed of patients <18 years of age, referred to a tertiary care children's hospital for PACL who also underwent at least 1 neck ultrasound from 2007 to 2021. Patients with acute neck infections, congenital masses, or known rheumatologic, immunologic, or malignant conditions were excluded. A multivariate logistic regression model was used to determine patient and nodal factors associated with the decision for operative management. SETTING University of California, San Francisco Pediatric Otolaryngology Department. RESULTS Among the 197 patients meeting inclusion criteria, 30 (15.2%) underwent surgical biopsy. Overall, 26% underwent repeat ultrasound with a mean interval of 6.6 months, and a mean decrease in nodal size of 0.34 cm. Of the 30 surgical cases, 27 (90%) patients had benign pathology. Multivariate regression analysis revealed pain (p = .04), firmness (p < .001), and lack of a normal fatty hilum on ultrasound (p = .04) as statistically significantly correlated with decisions for surgical management. CONCLUSION The majority of pediatric PACL is benign and does not require an excisional biopsy to rule out lymphoma. Serial clinical follow-up with neck ultrasound can be used to safely monitor patients.
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Affiliation(s)
- Jacqueline E Harris
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco Benioff Children's Hospital, San Francisco, California, USA
| | - Neil N Patel
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco Benioff Children's Hospital, San Francisco, California, USA
| | - Katherine Wai
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco Benioff Children's Hospital, San Francisco, California, USA
| | - Kristina W Rosbe
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco Benioff Children's Hospital, San Francisco, California, USA
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Huo LM, Li LM, Peng HY, Wang LJ, Feng ZY. Kawasaki disease with peritonsillar abscess as the first symptom: A case report. World J Clin Cases 2023; 11:5391-5397. [PMID: 37621581 PMCID: PMC10445059 DOI: 10.12998/wjcc.v11.i22.5391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/25/2023] [Accepted: 07/17/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Kawasaki disease (KD), also known as mucocutaneous lymph node syndrome, is an acute, self-limiting vasculitis of unknown aetiology that mainly involves the medium and small arteries and can lead to serious cardiovascular complications, with a 25% incidence of coronary artery aneurysms. Periton-Sillar abscesses are a rare symptom of KD and is easily misdiagnosed at its early stages. CASE SUMMARY A 5-year-old boy who presented to a community hospital with a 3-d fever, difficulty in opening his mouth, and neck pain and was originally treated for throat infection without improvement. On the basis of laboratory tests, ultrasound of submandibular and superficial lymph nodes and computed tomography of the neck, the clinician diagnosed the periamygdala abscess and sepsis that did not resolve after antibiotic therapy. On the fifth day of admission, the child developed conjunctival congestion, prune tongue, perianal congestion and desquamation, and slightly stiff and swollen bunions on both feet. A diagnosis of KD was reached with complete remission after intravenous immunoglobulin treatment. CONCLUSION Children with neck pain, lymph node enlargement, or airway obstruction as the main manifestations are poorly treated with intravenous broad-spectrum antibiotics. Clinicians should not rush invasive operations such as neck puncture, incision, and drainage and should be alert for KD when it cannot be explained by deep neck space infection and early treatment with aspirin combined with gammaglobulin.
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Affiliation(s)
- Li-Man Huo
- Department of Pharmacy, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Li-Min Li
- Department of Paediatrics, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Hao-Yang Peng
- Department of Ultrasound, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Li-Jia Wang
- Department of Medical Imaging, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Zhang-Ying Feng
- Department of Clinical Pharmacology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
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Huo LM, Li LM, Peng HY, Wang LJ, Feng ZY. Kawasaki disease with peritonsillar abscess as the first symptom: A case report. World J Clin Cases 2023; 11:5385-5391. [DOI: 10.12998/wjcc.v11.i22.5385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/25/2023] [Accepted: 07/17/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Kawasaki disease (KD), also known as mucocutaneous lymph node syndrome, is an acute, self-limiting vasculitis of unknown aetiology that mainly involves the medium and small arteries and can lead to serious cardiovascular complications, with a 25% incidence of coronary artery aneurysms. Periton–Sillar abscesses are a rare symptom of KD and is easily misdiagnosed at its early stages.
CASE SUMMARY A 5-year-old boy who presented to a community hospital with a 3-d fever, difficulty in opening his mouth, and neck pain and was originally treated for throat infection without improvement. On the basis of laboratory tests, ultrasound of submandibular and superficial lymph nodes and computed tomography of the neck, the clinician diagnosed the periamygdala abscess and sepsis that did not resolve after antibiotic therapy. On the fifth day of admission, the child developed conjunctival congestion, prune tongue, perianal congestion and desquamation, and slightly stiff and swollen bunions on both feet. A diagnosis of KD was reached with complete remission after intravenous immunoglobulin treatment.
CONCLUSION Children with neck pain, lymph node enlargement, or airway obstruction as the main manifestations are poorly treated with intravenous broad-spectrum antibiotics. Clinicians should not rush invasive operations such as neck puncture, incision, and drainage and should be alert for KD when it cannot be explained by deep neck space infection and early treatment with aspirin combined with gammaglobulin.
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Affiliation(s)
- Li-Man Huo
- Department of Pharmacy, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Li-Min Li
- Department of Paediatrics, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Hao-Yang Peng
- Department of Ultrasound, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Li-Jia Wang
- Department of Medical Imaging, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Zhang-Ying Feng
- Department of Clinical Pharmacology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
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Thompson JA, Bertoni D, Decuzzi J, Isaiah A, Pereira KD. Ultrasound versus fine needle aspiration for the initial evaluation of pediatric cervical lymphadenopathy-A systematic review. Int J Pediatr Otorhinolaryngol 2023; 166:111485. [PMID: 36812785 DOI: 10.1016/j.ijporl.2023.111485] [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: 12/12/2022] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVE Cervical lymphadenopathy is a frequent finding in children that poses diagnostic challenges. We sought to compare the utility of fine needle aspiration (FNA) with ultrasound (US) for evaluating pediatric cervical lymphadenopathy based on published literature. STUDY DESIGN In October 2019, we performed a comprehensive electronic search of PubMed, OVID (MEDLINE), EMBASE, and Scopus databases. Two authors independently screened and assessed full-text reports of potentially eligible studies. We compared sensitivity, specificity, positive predictive value estimates, and balanced accuracy for determining the underlying etiology of lymphadenopathy. RESULTS The initial search returned 7736 possible studies, of which 31 met the criteria for inclusion. A total of 25 studies were included in the final analysis, with a total of 4721 patients, of which 52.8% were male. Of these, 9 (36.0%) examined US, and 16 (64%) examined fine needle aspiration. The pooled balanced accuracy for determining etiology was 87.7% for US and 92.9% for FNA. Reactive lymphadenopathy was identified in 47.9%, 9.2% were malignant, 12.6% were granulomatous, and 6.6% were non-diagnostic. CONCLUSIONS In this systematic review, US was identified as an accurate initial diagnostic imaging modality in children. Fine needle aspiration was found to play a significant role in ruling out malignant lesions and potentially avoiding excisional biopsy.
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Affiliation(s)
- Joshua A Thompson
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Dylan Bertoni
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Julianna Decuzzi
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Amal Isaiah
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kevin D Pereira
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA.
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Zijtregtop EAM, Winterswijk LA, Beishuizen TPA, Zwaan CM, Nievelstein RAJ, Meyer-Wentrup FAG, Beishuizen A. Machine Learning Logistic Regression Model for Early Decision Making in Referral of Children with Cervical Lymphadenopathy Suspected of Lymphoma. Cancers (Basel) 2023; 15:cancers15041178. [PMID: 36831520 PMCID: PMC9954739 DOI: 10.3390/cancers15041178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
While cervical lymphadenopathy is common in children, a decision model for detecting high-grade lymphoma is lacking. Previously reported individual lymphoma-predicting factors and multivariate models were not sufficiently discriminative for clinical application. To develop a diagnostic scoring tool, we collected data from all children with cervical lymphadenopathy referred to our national pediatric oncology center within 30 months (n = 182). Thirty-nine putative lymphoma-predictive factors were investigated. The outcome groups were classical Hodgkin lymphoma (cHL), nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL), non-Hodgkin lymphoma (NHL), other malignancies, and a benign group. We integrated the best univariate predicting factors into a multivariate, machine learning model. Logistic regression allocated each variable a weighing factor. The model was tested in a different patient cohort (n = 60). We report a 12-factor diagnostic model with a sensitivity of 95% (95% CI 89-98%) and a specificity of 88% (95% CI 77-94%) for detecting cHL and NHL. Our 12-factor diagnostic scoring model is highly sensitive and specific in detecting high-grade lymphomas in children with cervical lymphadenopathy. It may enable fast referral to a pediatric oncologist in patients with high-grade lymphoma and may reduce the number of referrals and unnecessary invasive procedures in children with benign lymphadenopathy.
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Affiliation(s)
- Eline A. M. Zijtregtop
- Department of Pediatric Hemato-Oncology, Princess Máxima Centre for Pediatric Oncology, Heidelberglaan 25, 3585 CS Utrecht, The Netherlands
- Department of Pediatric Hematology and Oncology, Erasmus Medical Centre-Sophia Children’s Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Louise A. Winterswijk
- Department of Pediatric Hemato-Oncology, Princess Máxima Centre for Pediatric Oncology, Heidelberglaan 25, 3585 CS Utrecht, The Netherlands
- Department of Pediatric Hematology and Oncology, Erasmus Medical Centre-Sophia Children’s Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Tammo P. A. Beishuizen
- Department of Pediatric Hemato-Oncology, Princess Máxima Centre for Pediatric Oncology, Heidelberglaan 25, 3585 CS Utrecht, The Netherlands
| | - Christian M. Zwaan
- Department of Pediatric Hemato-Oncology, Princess Máxima Centre for Pediatric Oncology, Heidelberglaan 25, 3585 CS Utrecht, The Netherlands
- Department of Pediatric Hematology and Oncology, Erasmus Medical Centre-Sophia Children’s Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Rutger A. J. Nievelstein
- Department of Pediatric Hemato-Oncology, Princess Máxima Centre for Pediatric Oncology, Heidelberglaan 25, 3585 CS Utrecht, The Netherlands
- Division Imaging & Oncology, Department of Radiology & Nuclear Medicine, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Friederike A. G. Meyer-Wentrup
- Department of Pediatric Hemato-Oncology, Princess Máxima Centre for Pediatric Oncology, Heidelberglaan 25, 3585 CS Utrecht, The Netherlands
| | - Auke Beishuizen
- Department of Pediatric Hemato-Oncology, Princess Máxima Centre for Pediatric Oncology, Heidelberglaan 25, 3585 CS Utrecht, The Netherlands
- Department of Pediatric Hematology and Oncology, Erasmus Medical Centre-Sophia Children’s Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
- Correspondence: ; Tel.: +31-88-9727272
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Wilkinson S, Stubington T, Charlton A, Cole S, Elloy M. Comparison of clinical estimations and radiological measurements in the context of paediatric cervical masses: How accurate are we? Int J Pediatr Otorhinolaryngol 2022; 163:111361. [PMID: 36283189 DOI: 10.1016/j.ijporl.2022.111361] [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: 07/06/2022] [Revised: 09/24/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Cervical masses represent a common presentation to the paediatric ENT outpatient clinic. Despite their high prevalence, few represent an underlying malignant pathology. Currently, there is no universally accepted algorithm for management of such cases in the United Kingdom. Local guidance often centres around clinical interpretation of size when determining the need for investigation. With such emphasis placed on size, the authors sought to investigate the accuracy of physician palpation and in turn explore the validity of common referral pathways. METHODS A retrospective methodology was used to address the research objective. All paediatric ultrasound scans conducted during a 24-month period were reviewed to compare the clinical and radiological assessments of diameter. A 2 tailed paired student's t-test was selected to evaluate the differences between the two measurements and ultimately assess clinician accuracy. RESULTS 753 paediatric cervical ultrasound scans were conducted during the 2-year period. Initial analysis identified three discrete ultrasonographically diagnostic groups: lymph nodes (n = 532), non-lymph node masses (n = 162) and normal anatomy (n = 59). Further analysis of clinical estimation and radiological measurement demonstrated a statistically significant difference (p < 0.02) for the lymph-node group. A statistically significant difference was not demonstrated within the non-lymph node group (p = 0.66). When clinician assessment resulted in a value outside of what was considered accurate, lymph node sizes were predominantly overestimated (62/91, 68%). Conversely, non-lymph node masses where the clinical measurement was not within 5 mm of the ultrasound measurement were more commonly underestimated in size (11/45, 55%) but this was not statistically significant. CONCLUSIONS Our study demonstrates a statistically significant tendency for clinicians to overestimate paediatric cervical lymphadenopathy. Calliper measurement may further improve accuracy of assessment.
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Affiliation(s)
- Sophie Wilkinson
- University Hospitals Leicester - Leicester Royal Infirmary, Infirmary Square, Leicester, LE15WW, UK.
| | - Thomas Stubington
- University Hospitals Leicester - Leicester Royal Infirmary, Infirmary Square, Leicester, LE15WW, UK.
| | - Alex Charlton
- Nottingham University Hospitals - Derby Road, Lenton, Nottingham, NG72UH, UK.
| | - Simon Cole
- University Hospitals Leicester - Leicester Royal Infirmary, Infirmary Square, Leicester, LE15WW, UK.
| | - Marianne Elloy
- University Hospitals Leicester - Leicester Royal Infirmary, Infirmary Square, Leicester, LE15WW, UK.
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Kukla R, Kračmarová R, Ryšková L, Bavlovič J, Pellantová V, Bolehovská R, Fajfr M, Pavlík I, Boštík P. Francisella tularensis caused cervical lymphadenopathy in little children after a tick bite: Two case reports and a short literature review. Ticks Tick Borne Dis 2021; 13:101893. [PMID: 34990926 DOI: 10.1016/j.ttbdis.2021.101893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/17/2022]
Abstract
Although Francisella (F.) tularensis is a well-described and understood zoonotic pathogen, its importance in Central Europe is relatively minor and, as such, tularaemia may be missed in the differential diagnosis. The annual incidence of tularaemia in the Czech Republic is relatively stable with up to 100 reported cases per year, except in the epidemic years 1998 and 1999 with 225 and 222 reported cases, respectively. It is, however, higher in comparison with the neighbouring countries. The common route of transmission in Central Europe is handling infected animals. Tularaemia is not commonly recognized as a tick-borne disease. Here we report two rare cases of a tick bite-associated ulceroglandular form of tularaemia in 2.5-year-old and 6.5-year-old children presenting with cervical lymphadenopathy. The unusual and interesting features of those cases are the young age and relatively uncommon route of transmission suggesting possible changes in the epidemiology of tularaemia in the Czech Republic. Therefore, the infection with F. tularensis should be considered in the differential diagnosis after a tick bite even in infants.
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Affiliation(s)
- Rudolf Kukla
- Institute of Clinical Microbiology, University Hospital and Charles University, Faculty of Medicine in Hradec Králové, Sokolská 581, 50005 Hradec Králové, Czech Republic
| | - Renata Kračmarová
- Clinic of Infectious Diseases, University Hospital, Sokolská 581, 50005 Hradec Králové, Czech Republic
| | - Lenka Ryšková
- Institute of Clinical Microbiology, University Hospital and Charles University, Faculty of Medicine in Hradec Králové, Sokolská 581, 50005 Hradec Králové, Czech Republic
| | - Jan Bavlovič
- Institute of Clinical Microbiology, University Hospital and Charles University, Faculty of Medicine in Hradec Králové, Sokolská 581, 50005 Hradec Králové, Czech Republic; Department of Molecular Pathology and Biology, Faculty of Military Health Sciences, University of Defence, Trebešská 1575, 50001 Hradec Králové, Czech Republic
| | - Věra Pellantová
- Clinic of Infectious Diseases, University Hospital, Sokolská 581, 50005 Hradec Králové, Czech Republic
| | - Radka Bolehovská
- Institute of Clinical Microbiology, University Hospital and Charles University, Faculty of Medicine in Hradec Králové, Sokolská 581, 50005 Hradec Králové, Czech Republic
| | - Miroslav Fajfr
- Institute of Clinical Microbiology, University Hospital and Charles University, Faculty of Medicine in Hradec Králové, Sokolská 581, 50005 Hradec Králové, Czech Republic
| | - Ivo Pavlík
- Faculty of Regional Development and International Studies, Mendel University in Brno, tr. Generála Píky 7, 61300, Brno, Czech Republic
| | - Pavel Boštík
- Institute of Clinical Microbiology, University Hospital and Charles University, Faculty of Medicine in Hradec Králové, Sokolská 581, 50005 Hradec Králové, Czech Republic.
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Pecora F, Abate L, Scavone S, Petrucci I, Costa F, Caminiti C, Argentiero A, Esposito S. Management of Infectious Lymphadenitis in Children. CHILDREN-BASEL 2021; 8:children8100860. [PMID: 34682125 PMCID: PMC8535130 DOI: 10.3390/children8100860] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/22/2021] [Accepted: 09/22/2021] [Indexed: 01/22/2023]
Abstract
Lymphadenopathy is an irregularity in the size and texture of the lymph nodes, which is quite common in childhood. When the enlargement of lymph nodes is caused by inflammatory and infectious processes, it is called lymphadenitis. The main objective of this manuscript is to summarize the common infectious etiologies and presentations of lymphadenitis in children providing a management guide for clinical practice. PubMed was used to search for all of the studies published up to April 2021 using keywords such as "lymphadenitis" and "children". Literature analysis showed that the differential diagnosis for lymphadenitis in pediatrics is broad. Although lymph node enlargement in children is usually benign and self-limited, it is important to exclude malignant etiology. In most cases, history and physical examination allow to identify the correct diagnosis and start a proper treatment with a prompt resolution of the lymphadenopathy. However, particularly in the case of persistent lymphadenitis, determining the cause of lymph node enlargement may be difficult, and the exact etiology may not be identified despite extensive investigations. Further studies should develop and validate an algorithm to assist pediatricians in the diagnosis and timely treatment of lymphadenitis, suggesting situations in which a watchful waiting may be considered a safe approach, those in which empiric antibiotic therapy should be administered, and those requiring a timely diagnostic work-up.
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Affiliation(s)
- Francesco Pecora
- Paediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, via Gramsci 14, 43126 Parma, Italy; (F.P.); (L.A.); (S.S.); (I.P.); (F.C.); (A.A.)
| | - Luciana Abate
- Paediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, via Gramsci 14, 43126 Parma, Italy; (F.P.); (L.A.); (S.S.); (I.P.); (F.C.); (A.A.)
| | - Sara Scavone
- Paediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, via Gramsci 14, 43126 Parma, Italy; (F.P.); (L.A.); (S.S.); (I.P.); (F.C.); (A.A.)
| | - Irene Petrucci
- Paediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, via Gramsci 14, 43126 Parma, Italy; (F.P.); (L.A.); (S.S.); (I.P.); (F.C.); (A.A.)
| | - Federico Costa
- Paediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, via Gramsci 14, 43126 Parma, Italy; (F.P.); (L.A.); (S.S.); (I.P.); (F.C.); (A.A.)
| | - Caterina Caminiti
- Research an Innovation Unit, University Hospital of Parma, via Gramsci 14, 43126 Parma, Italy;
| | - Alberto Argentiero
- Paediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, via Gramsci 14, 43126 Parma, Italy; (F.P.); (L.A.); (S.S.); (I.P.); (F.C.); (A.A.)
| | - Susanna Esposito
- Paediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, via Gramsci 14, 43126 Parma, Italy; (F.P.); (L.A.); (S.S.); (I.P.); (F.C.); (A.A.)
- Correspondence: ; Tel.: +39-0521-903-524
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13
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Shin M, Prasad A, Arguelles GR, Wakim JJ, Chorath K, Moreira A, Rajasekaran K. Appraisal of clinical practice guidelines for the evaluation and management of neck masses in children. J Paediatr Child Health 2021; 57:803-809. [PMID: 33876530 DOI: 10.1111/jpc.15516] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/30/2021] [Accepted: 04/04/2021] [Indexed: 12/12/2022]
Abstract
AIM The purpose of this systematic review was to use the Appraisal of Guidelines for Research and Evaluation tool to assess the methodological quality of clinical practice guidelines (CPGs) for the workup and management of paediatric neck masses. METHODS MEDLINE, Embase, Cochrane and grey literature were searched to identify CPG incorporating paediatric neck masses. Four authors with previous training of the Appraisal of Guidelines for Research and Evaluation tool evaluated the included studies. RESULTS Nine studies met inclusion criteria. The highest scoring domains were 'Scope and Purpose' (74.0 ± 4.5) and 'Clarity of Presentation' (72.9 ± 6.3). The lowest scoring domains were 'Rigour and Development' (18.8 ± 7.5) and 'Applicability' (23.7 ± 6.1). One study was 'High' quality, three received scores of 'Average' and five were found to be 'Low' quality. CONCLUSION The majority of paediatric neck mass CPGs were low to average quality. The domains in need of greatest improvement were 'Rigour and Development' and 'Applicability', suggesting significant concerns in current CPGs focused on paediatric neck masses.
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Affiliation(s)
- Max Shin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Aman Prasad
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Gabriel R Arguelles
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Jonathan J Wakim
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Kevin Chorath
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Alvaro Moreira
- Department of Pediatrics, University of Texas Health-San Antonio, San Antonio, Texas, United States
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, United States.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States
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Meadows O, Sarkodieh J. Ultrasound evaluation of persistent cervical lymph nodes in young children. Clin Radiol 2021; 76:315.e9-315.e12. [PMID: 33551150 DOI: 10.1016/j.crad.2020.12.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 12/22/2020] [Indexed: 12/16/2022]
Abstract
AIM To review the ultrasonographic outcomes of persistent lymph nodes, in the absence of other concerning signs or symptoms, in patients <6 years of age. MATERIALS AND METHODS A retrospective analysis was undertaken of 98 patients <6 years old who had neck ultrasound for persistent lymph nodes at a single university hospital over a 3.5 year period between January 2016 and June 2019. RESULTS There were no cases of malignant disease or serious systemic illness. Ninety-two of the 98 examinations showed normal or reactive lymph nodes. There were three sonographically indeterminate cases and two non-lymph-node structures: haemangioma and dermoid cyst. One examination reported an abnormal lymph node, which had resolved by the time of review in clinic. CONCLUSION Persistently enlarged or abnormal lymph nodes should be investigated; however, a distinction should be made between lymph nodes that have regressed to <1 cm but are still palpable and persistently enlarged or abnormal lymph nodes. The findings of the present study indicate that persistence of non-enlarged lymph nodes is not a predictor for malignancy. It is advised that clear guidelines are used, which state the criteria for further investigation, to promote the best use of imaging.
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Affiliation(s)
- O Meadows
- Barts Health NHS Trust, Whipps Cross Hospital, London, UK.
| | - J Sarkodieh
- Barts Health NHS Trust, Whipps Cross Hospital, London, UK
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15
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Claviez A, Borkhardt A. Aktualisierte Handlungsempfehlung nach der Leitlinie Lymphknotenvergrößerung. Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-020-01023-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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Darré T, Doukouré B, Djiwa T, Amana B, Bissa H, Napo-Koura G. Cervical lymphadenopathy of Togolese children in a tropical context: clinicopathological study. Trop Doct 2020; 51:96-99. [PMID: 32814507 DOI: 10.1177/0049475520947882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our study describes the epidemiology and aetiology of cervical lymphadenopathy in children diagnosed between 2003 and 2017 at the pathology laboratory of Lomé, Togo. A total of 221 cases were collected. The average age of diagnosis of the study population was 9.8 ± 0.3 years and consisted of 118 (53.4%) boys. HIV was confirmed by indirect ELISA test in 69 (31.2%) cases. The cohort consisted of infections (n = 128, 57.9%), tumours (n = 85, 38.5%) and others (n = 8, 1.6%). The main infectious aetiology was tuberculosis (n = 84). Tumour aetiology consisted of 79 primary malignancies and three metastatic cases. Primary tumours consisted predominantly of lymphoma (n = 74), with Burkitt's lymphoma (n = 44) being the most common. Tuberculosis on a background of HIV infection remains the dominant cause of cervical lymphadenopathy in the tropical region of Togo.
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Affiliation(s)
- Tchin Darré
- MD, Professor, Department of Pathology, University Teaching Hospital of Lomé, Togo
| | - Brahima Doukouré
- MD, Professor, Department of Pathology, University Teaching Hospital of Cocody, Abidjan, Ivory Coast
| | - Toukilnan Djiwa
- MD, Assistant-Professor, Department of Pathology, University Teaching Hospital of Lomé, Togo
| | - Bathokédeou Amana
- MD, Professor, Department of Head and Neck Surgical, University Teaching Hospital of Lomé, Togo
| | - Haréfétéguéna Bissa
- MD, Assistant-Professor, Department of Stomatology, University Teaching Hospital of Lomé, Togo
| | - Gado Napo-Koura
- MD, PHD, Professor, Department of Pathology, University Teaching Hospital of Lomé, Togo
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17
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Venturini E, Grillandini C, Bianchi L, Montagnani C, Chiappini E, Galli L. Clinical features and outcomes of lymphadenopathy in a tertiary children's hospital. J Paediatr Child Health 2020; 56:1277-1282. [PMID: 32436627 DOI: 10.1111/jpc.14922] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/11/2020] [Accepted: 04/14/2020] [Indexed: 02/01/2023]
Abstract
AIM The aim of the present study is to describe the clinical features and outcomes of childhood lymphadenopathy and to define factors able to predict neoplastic aetiology or may improve its prognosis. METHODS All children evaluated for lymphadenopathy in our tertiary children's hospital and who underwent their first examination between 1 January, 2015 and 31 December, 2017 were enrolled in this retrospective observational study. Data were analysed using SPSS.Statistics, 24.0. RESULTS A total of 322 children, aged between 0 and 18 years (median 4.5; interquartile range 2.5-9), were enrolled. A specific diagnosis was achieved in almost half of the cases (n = 159, 49.4%) by using one or more methods, including serological, microbiological, biomolecular or histological investigations on surgical samples. Epstein Barr virus and non-tuberculous mycobacteria were the most common etiological agents among acute/sub-acute and chronic lymphadenopathy, respectively. At the end of the study period, two-thirds (210, 65.2%) of enrolled patients were successfully treated. Malignancies and non-tuberculous mycobacteria infections had the longest time to resolution. CONCLUSIONS Our data suggest that lymphadenopathy is a benign condition in most cases. Of note in our study, 2.5% of lymphadenopathy cases were found to be due to oncologic conditions. The most frequent infective causes were Epstein Barr virus, bacteria and non-tuberculous mycobacteria infections. No haematic or ultrasonographic features were independently able to provide sufficient evidence for a conclusive diagnosis. However, utilising these findings alongside evaluation for clinical criteria can guide decision-making for physicians. Lymphadenectomy is the most appropriate process to follow in the event of chronic lymphadenopathy with undefined diagnosis.
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Affiliation(s)
- Elisabetta Venturini
- Division of Pediatric Infectious Disease, Anna Meyer Children's University Hospital, Florence, Italy.,Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Leila Bianchi
- Division of Pediatric Infectious Disease, Anna Meyer Children's University Hospital, Florence, Italy
| | - Carlotta Montagnani
- Division of Pediatric Infectious Disease, Anna Meyer Children's University Hospital, Florence, Italy
| | - Elena Chiappini
- Division of Pediatric Infectious Disease, Anna Meyer Children's University Hospital, Florence, Italy.,Department of Health Sciences, University of Florence, Florence, Italy
| | - Luisa Galli
- Division of Pediatric Infectious Disease, Anna Meyer Children's University Hospital, Florence, Italy.,Department of Health Sciences, University of Florence, Florence, Italy
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18
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Park JE, Ryu YJ, Kim JY, Kim YH, Park JY, Lee H, Choi HS. Cervical lymphadenopathy in children: a diagnostic tree analysis model based on ultrasonographic and clinical findings. Eur Radiol 2020; 30:4475-4485. [PMID: 32189052 DOI: 10.1007/s00330-020-06794-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 02/26/2020] [Accepted: 03/05/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To establish a diagnostic tree analysis (DTA) model based on ultrasonography (US) findings and clinical characteristics for differential diagnosis of common causes of cervical lymphadenopathy in children. METHODS A total of 242 patients (131 boys, 111 girls; mean age, 11.2 ± 0.3 years; range, 1 month-18 years) with pathologically confirmed Kikuchi disease (n = 127), reactive hyperplasia (n = 64), lymphoma (n = 24), or suppurative lymphadenitis (n = 27) who underwent neck US were included. US images were retrospectively reviewed to assess lymph node (LN) characteristics, and clinical information was collected from patient records. DTA models were created using a classification and regression tree algorithm on the basis of US imaging and clinical findings. The patients were randomly divided into training (70%, 170/242) and validation (30%, 72/242) datasets to assess the diagnostic performance of the DTA models. RESULTS In the DTA model based on all predictors, perinodal fat hyperechogenicity, LN echogenicity, and short diameter of the largest LN were significant predictors for differential diagnosis of cervical lymphadenopathy (overall accuracy, 85.3% and 83.3% in the training and validation datasets). In the model based on categorical parameters alone, perinodal fat hyperechogenicity, LN echogenicity, and loss of fatty hilum were significant predictors (overall accuracy, 84.7% and 86.1% in the training and validation datasets). CONCLUSIONS Perinodal fat hyperechogenicity, heterogeneous echotexture, short diameter of the largest LN, and loss of fatty hilum were significant US findings in the DTA for differential diagnosis of cervical lymphadenopathy in children. KEY POINTS • Diagnostic tree analysis model based on ultrasonography and clinical findings would be helpful in differential diagnosis of pediatric cervical lymphadenopathy. • Significant predictors were perinodal fat hyperechogenicity, heterogeneous echotexture, short diameter of the largest LN, and loss of fatty hilum.
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Affiliation(s)
- Ji Eun Park
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, 13620, South Korea
| | - Young Jin Ryu
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, 13620, South Korea. .,Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
| | - Ji Young Kim
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, 13620, South Korea.,Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Young Hoon Kim
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, 13620, South Korea.,Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Ji Young Park
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hyunju Lee
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyoung Soo Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
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Isidori C, Sebastiani L, Esposito S. A Case of Incomplete and Atypical Kawasaki Disease Presenting with Retropharyngeal Involvement. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183262. [PMID: 31491922 PMCID: PMC6765912 DOI: 10.3390/ijerph16183262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/25/2019] [Accepted: 08/27/2019] [Indexed: 12/29/2022]
Abstract
Background: Kawasaki disease (KD) is a childhood acute febrile vasculitis of unknown aetiology. The diagnosis is based on clinical criteria, including unilateral cervical lymphadenopathy, which is the only presenting symptom associated with fever in 12% of cases. A prompt differential diagnosis distinguishing KD from infective lymphadenitis is therefore necessary to avoid incorrect and delayed diagnosis and the risk of cardiovascular sequelae. Case presentation: We describe the case of a 4 years old boy presenting with febrile right cervical lymphadenopathy, in which the unresponsiveness to broad-spectrum antibiotics, the following onset of other characteristic clinical features and the evidence on the magnetic resonance imaging (MRI) of retropharyngeal inflammation led to the diagnosis of incomplete and atypical KD. On day 8 of hospitalisation (i.e., 13 days after the onset of symptoms), one dose of intravenous immunoglobulins (IVIG; 2 g/kg) was administered with rapid defervescence, and acetylsalicylic acid (4 mg/kg/day) was started and continued at home for a total of 8 weeks. Laboratory examinations revealed a reduction in the white blood cell count and the levels of inflammatory markers, thrombocytosis, and persistently negative echocardiography. Clinically, we observed a gradual reduction of the right-side neck swelling. Fifteen days after discharge, the MRI of the neck showed a regression of the laterocervical lymphadenopathy and a resolution of the infiltration of the parapharyngeal and retropharyngeal spaces. Conclusion: Head and neck manifestations can be early presentations of KD, which is frequently misdiagnosed as suppurative lymphadenitis or retropharyngeal infection. A growing awareness of the several possible presentations of KD is therefore necessary. Computed tomography (CT) or MRI can be utilised to facilitate the diagnosis.
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Affiliation(s)
- Chiara Isidori
- Department of Surgical and Biomedical Sciences, University of Perugia, 06132 Perugia, Italy.
| | - Lisa Sebastiani
- Department of Surgical and Biomedical Sciences, University of Perugia, 06132 Perugia, Italy.
| | - Susanna Esposito
- Department of Medical and Surgical Sciences, University of Parma, 43126 Parma, Italy.
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20
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Della Bella C, Venturini E, Devente S, Piccini P, Tapinassi S, Bianchi L, Grassi A, Benagiano M, Alnwaisri HFM, Montagnani C, Chiappini E, Bitter W, D’Elios MM, de Martino M, Galli L. Role of Mycobacterium avium lysate INF-γ, IL-17, and IL-2 ELISPOT assays in diagnosing nontuberculous mycobacteria lymphadenitis in children. Eur J Clin Microbiol Infect Dis 2019; 38:1113-1122. [DOI: 10.1007/s10096-019-03506-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 02/06/2019] [Indexed: 11/29/2022]
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21
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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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Abstract
Actually, there is still no consensus related to diagnostic and management algorithms in case of head and neck lymphadenopathy in children. The aim of our study was to analyze the causes of head and neck lymphadenopathy in children to determine a systematic diagnostic approach. We enrolled all cases of head and neck lymphadenopathy in children under the age of 18 diagnosed at the Unit of Hemato-Oncology, Pediatric Department of University "Luigi Vanvitelli," Naples, over a 15-year period (January 2003-December 2017). In total, 405 patients (271 males) were enrolled in the study. Thirteen cases due to other causes, were left off the study. Therefore, the study was performed on 392 cases. A total of 220 patients (56.1%) had a history of infection, 66 cases (16.8%) a diagnosis of neoplasia, and 101 (24.9%) cases a diagnosis of reactive inflammatory changes of nonspecific origin. We have observed the following from our study: (1) the acute infections are the most common causes of head and neck lymphadenopathy in the pediatric population; (2) in about a quarter of patients, the lymphadenopathy resulted by nonspecific origin; (3) the supraclavicular nodes should be regarded with a high index of suspicion of malignancy.
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23
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Akute Vorstellungsanlässe. PRAXISHANDBUCH DER PÄDIATRISCHEN GRUNDVERSORGUNG 2017. [PMCID: PMC7158195 DOI: 10.1016/b978-3-437-21281-9.00006-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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24
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Abstract
BACKGROUND Antibiotics are among the drugs most commonly prescribed to children in hospitals and communities. Unfortunately, a great number of these prescriptions are unnecessary or inappropriate. Antibiotic abuse and misuse have several negative consequences, including drug-related adverse events, the emergence of multidrug resistant bacterial pathogens, the development of Clostridium difficile infection, the negative impact on microbiota, and undertreatment risks. In this paper, the principle of and strategies for paediatric antimicrobial stewardship (AS) programs, the effects of AS interventions and the common barriers to development and implementation of AS programs are discussed. DISCUSSION Over the last few years, there have been significant shortages in the development and availability of new antibiotics; therefore, the implementation of strategies to preserve the activity of existing antimicrobial agents has become an urgent public health priority. AS is one such approach. The need for formal AS programs in paediatrics was officially recognized only recently, considering the widespread use of antibiotics in children and the different antimicrobial resistance patterns that these subjects exhibit in comparison to adult and elderly patients. However, not all problems related to the implementation of AS programs among paediatric patients are solved. The most important remaining problems involve educating paediatricians, creating a multidisciplinary interprofessional AS team able to prepare guidelines, monitoring antibiotic prescriptions and defining corrective measures, and the availability of administrative consensuses with adequate financial support. Additionally, the problem of optimizing the duration of AS programs remains unsolved. Further studies are needed to solve the above mentioned problems. CONCLUSIONS In paediatric patients, as in adults, the successful implementation of AS strategies has had a significant impact on reducing targeted- and nontargeted-antimicrobial use by improving the quality of care for hospitalized patients and preventing the emergence of resistance. Considering that rationalization of antibiotic misuse and abuse is the basis for reducing emergence of bacterial resistance and several clinical problems, all efforts must be made to develop multidisciplinary paediatric AS programs in hospital and community settings.
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Affiliation(s)
- Nicola Principi
- Department of Pathophysiology and Transplantation, Pediatric Highly Intensive Care Unit, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Commenda 9, Milan, 20122 Italy
| | - Susanna Esposito
- Department of Pathophysiology and Transplantation, Pediatric Highly Intensive Care Unit, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Commenda 9, Milan, 20122 Italy
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