From the Guidelines
The workup for an enlarged cervical lymph node should begin with a thorough history and physical examination, focusing on the duration, associated symptoms, and risk factors for malignancy, and a lymph node biopsy should be performed if the node is larger than 1.5 cm in greatest transverse long axis diameter or if there are concerning features 1. The initial evaluation should include a complete blood count with differential, blood chemistry, and lactate dehydrogenase, as these tests can help identify potential causes of lymphadenopathy, such as infection or malignancy 1. Key points to consider in the workup include:
- History of waxing and waning of lesions, which may suggest a diagnosis of lymphomatoid papulosis 1
- Presence of B symptoms, such as fever, night sweats, or weight loss, which may indicate a more serious underlying condition 1
- Physical examination findings, such as the size and number of lesions, presence of patches or plaques, and hepatosplenomegaly 1
- Laboratory results, such as abnormal blood cell counts or chemistry tests, which may suggest extracutaneous disease 1 Imaging studies, such as ultrasound, CT, or positron emission tomography/CT, may be necessary to evaluate the extent of disease and guide further management 1. It is essential to differentiate between benign reactive lymphadenopathy and more serious conditions, such as lymphoma or metastatic cancer, which require prompt treatment 1. A systematic approach to the workup of an enlarged cervical lymph node, including a thorough history and physical examination, laboratory tests, and imaging studies, can help identify the underlying cause and guide appropriate management.
From the Research
Cervical Lymphadenopathy Workup
The workup for an enlarged cervical lymph node (cervical lymphadenopathy) involves a comprehensive approach to determine the underlying cause.
- The differential diagnosis includes thyroid malignancy, lymphoma, chronic infectious disorders, etc. 2
- Fine needle aspiration (FNA) is a useful diagnostic tool in the evaluation of cervical lymph nodes, especially in patients with no history of malignancy 3
- Sonographic characteristics such as the absence of an echogenic hilus can be indicative of malignancy 3
- In children, palpable cervical lymph nodes are most commonly the result of self-limiting infection, and are rarely the first indicator of a malignant process 4
Diagnostic Tools
- Fine needle aspiration cytology (FNAC) is a quick and safe method in the management of cervical lymph nodes, with a sensitivity of 95.5%, specificity of 98.7%, positive predictive value (PPV) of 97.7%, and negative predictive value (NPP) of 97.5% in the diagnosis of cervical lymph node lymphomas 5
- Biopsy of cervical lymph node is a valuable diagnostic tool, especially in patients with advanced age, large swollen lymph nodes, or high levels of serum soluble interleukin-2 receptor (sIL-2r) or lactate dehydrase (LDH) 6
Clinical Parameters
- Clinical parameters such as age, size of the lymph node, white blood cell (WBC), C reactive protein (CRP), lactate dehydrase (LDH), and soluble interleukin-2 receptor (sIL-2r) can be useful in evaluating patients with cervical lymph node enlargement 6
- Serum levels of LDH, sIL-2r, age, and lymph node size can be significantly higher in patients with malignant lymphoma compared to those with benign disease 6