Development of an algorithm for the management of cervical lymphadenopathy in children: consensus of the Italian Society of Preventive and Social Pediatrics, jointly with the Italian Society of Pediatric Infectious Diseases and the Italian Society of Pediatric Otorhinolaryngology

Cervical lymphadenopathy is a common disorder in children due to a wide spectrum of disorders. On the basis of a complete history and physical examination, paediatricians have to select, among the vast majority of children with a benign self-limiting condition, those at risk for other, more complex, diseases requiring laboratory tests, imaging and, finally, tissue sampling. At the same time, they should avoid expensive and invasive examinations when unnecessary. The Italian Society of Preventive and Social Pediatrics, jointly with the Italian Society of Pediatric Infectious Diseases, the Italian Society of Pediatric Otorhinolaryngology, and other Scientific Societies, issued a National Consensus document, based on the most recent literature findings, including an algorithm for the management of cervical lymphadenopathy in children.

METHODS

The Consensus Conference method was used, following the Italian National Plan Guidelines. Relevant publications in English were identified through a systematic review of MEDLINE and the Cochrane Database of Systematic Reviews from their inception through March 21, 2014.

RESULTS

Basing on literature results, an algorithm was developed, including several possible clinical scenarios. Situations requiring a watchful waiting strategy, those requiring an empiric antibiotic therapy, and those necessitating a prompt diagnostic workup, considering the risk for a severe underling disease, have been identified.

CONCLUSION

The present algorithm is a practice tool for the management of pediatric cervical lymphadenopathy in the hospital and the ambulatory settings. A multidisciplinary approach is paramount. Further studies are required for its validation in the clinical field.

Scalene node biopsy in diagnosis of intrathoracic diseases. Clinical notes

Scalene node biopsy (SNB) still represents a useful diagnostic method in the difficult interpretation of hilar-mediastinal adenopathies. Of 858 sample cases of intrathoracic pathologies of various etiology, SNB indicated a high histological degree of positivity in sarcoidosis in stages I and I + II (86%) and in malignant lymphomas (91%). As a result, the authors believe that when faced with a process of localization prevailing in the hilar-mediastinal lymphatic system, the SNB is a preferable treatment and should be performed before a mediastinoscopy.

[Daniels' prescalenic biopsy in the diagnosis of pulmonary sarcoidosis]

Prescalene biopsy according to Daniels has proved an excellent method for the histological detection of pulmonary sarcoidosis. Cooperation over a period of 15 years between the ear, nose and throat division of the Bassini Hospital, Milan, and the Lombardy Provincial Anti-TB Consortia (especially that of Milan) led to the performance of 533 biopsies in about 1700 cases with morphological and radiological pictures indicative of pulmonary sarcoidosis. Overall positivity was 81%. The disease has five radiological stages: I, I + II, II, II + III, and III. Patients with hilo-mediastinal polyadenopathy predominated numerically. Histological positivity greater in group A (stages I & I + II), i.e. 86%, 74% in group B (stage II), and 60% in group C (stages II + III, and III). The dependence of positivity on stage was further confirmed when series from different consortia were compared. Stress is laid on the high productivity of the method, its low risk, and its ready application to patients usually in apparently good health, following their detection by mass screening or general pneumological examinations.