From the Guidelines
Inguinal lymphadenopathy should be managed based on the underlying cause, with a thorough physical examination and history-taking as essential first steps, and further evaluation, including possible imaging studies or biopsy, should be considered for persistent or suspicious cases, as recommended by the most recent guidelines 1. When encountering inguinal lymphadenopathy, it is crucial to determine the underlying cause, which can range from localized infections, such as cellulitis or sexually transmitted infections, to malignancies affecting the lower extremities, genitalia, or lower abdominal regions.
- Normal inguinal lymph nodes can be palpable but are typically less than 1 cm in size; nodes larger than this warrant further investigation.
- The most common cause is localized infection in the drainage area, such as cellulitis, sexually transmitted infections, or skin infections of the legs or feet.
- Management depends on the underlying cause, with appropriate antibiotics like cephalexin 500 mg four times daily for 7-10 days prescribed for bacterial infections, and testing and targeted treatment necessary for suspected sexually transmitted infections.
- Persistent lymphadenopathy (lasting more than 4 weeks), nodes larger than 2 cm, hard or fixed nodes, or accompanying symptoms like fever, weight loss, or night sweats should prompt urgent referral for further evaluation, including possible imaging studies or biopsy to rule out malignancies such as lymphoma or metastatic cancer, as suggested by recent studies 1. The inguinal region contains superficial and deep lymph node groups that drain specific anatomical areas, which helps narrow down potential causes based on which nodes are affected.
- For patients with high-risk tumors, surgical staging is recommended, and inguinal lymph node dissection (ILND) is the most reliable surgical staging procedure, although it is associated with high morbidity 1.
- Dynamic sentinel node biopsy (DSNB) has the lowest morbidity while retaining high diagnostic accuracy, especially in high-volume centers, and is recommended for patients with intermediate-risk tumors or those who are not candidates for lymphadenectomy 1.
From the Research
Inguinal Lymphadenopathy
- Inguinal lymphadenopathy can be a result of various causes, including benign infectious causes and malignancy 2
- The diagnosis of inguinal lymphadenopathy is usually made on the basis of a careful history and physical examination, with localized adenopathy prompting a search for an adjacent precipitating lesion and an examination of other nodal areas to rule out generalized lymphadenopathy 2
- Inguinal lymphadenopathy can be associated with ovarian cancer, with a study finding that it can occur via lymphatic or hematogenous route and may not be as uncommon as previously thought 3
- The management of inguinal lymphadenopathy depends on the underlying cause, with options including observation, biopsy, and surgical excision 2, 4, 5
Diagnostic Approaches
- Ultrasonography and fine-needle aspiration can be used to diagnose inguinal lymphadenopathy, with a study finding that dynamic sentinel lymph node biopsy can accurately stage men with both impalpable and palpable inguinal lymph nodes 6
- Cross-sectional imaging and fine-needle aspirate cytology can also be used to guide decision-making for the use of platinum-based neoadjuvant chemotherapy followed by inguinal lymph node dissection 5
Management Options
- Surgical resection can play an important diagnostic, therapeutic, and guiding role in the management of inguinal lymphadenopathy, particularly in cases of bulky inguinal metastasis 5
- Immediate sartorius transposition and reconstruction with pedicled anterolateral thigh flap can be used to manage inguinal lymphadenectomy and recurrence, with a study finding that these methods can ensure low complication rates with no donor site morbidity 4