From the Guidelines
The workup for an enlarged cervical lymph node should begin with a thorough history and physical examination, followed by standard laboratory tests, and imaging studies such as PET/CT or diagnostic contrast-enhanced CT, with excisional lymph node biopsy being the preferred method for diagnosis, as recommended by the NCCN guidelines 1. The initial evaluation should focus on identifying potential risk factors for malignancy, such as age, duration of symptoms, and associated symptoms like fever, night sweats, or weight loss.
- Key components of the workup include:
- A thorough history and physical examination to identify potential risk factors and associated symptoms
- Standard laboratory tests, including complete blood count, comprehensive metabolic panel, and inflammatory markers like ESR and CRP
- Imaging studies, such as PET/CT or diagnostic contrast-enhanced CT, to evaluate the extent of lymphadenopathy and potential involvement of other lymphoid organs
- Excisional lymph node biopsy, which is the preferred method for diagnosis, as it provides a definitive diagnosis and allows for histopathological examination and immunophenotyping 1
- The role of fine-needle aspiration (FNA) biopsy is limited, and it is not recommended as the sole diagnostic method, except in unusual circumstances where it is judged to be diagnostic of Hodgkin lymphoma by an expert hematopathologist or cytopathologist 1.
- The workup should also include evaluation of ejection fraction, HIV and hepatitis B or C testing, and pulmonary function tests, as recommended by the NCCN guidelines 1.
- A diagnostic neck CT scan with contrast may be useful in select cases, particularly if the neck is positive on PET/CT or if radiation therapy to the neck is planned 1.
- The most recent and highest quality study, the NCCN guidelines 1, recommends a comprehensive staging procedure, including bone marrow biopsy and CT scans of the abdomen and thorax, to evaluate the extent of disease and potential involvement of other lymphoid organs.
From the Research
Diagnostic Approach
The workup for an enlarged cervical lymph node (cervical lymphadenopathy) involves a thorough clinical examination and various diagnostic tests to rule out malignancy and determine the underlying cause.
- A biopsy and histological examination of the lymph node are crucial for diagnosis, especially if the swelling persists 2.
- Fine needle aspiration cytology (FNAC) is a valuable diagnostic tool for evaluating cervical lymphadenopathy, providing a rapid and accurate diagnosis in most cases 3.
- Ultrasound (US) and virtual touch imaging quantification (VTIQ) can also be used to evaluate cervical lymph nodes, helping to differentiate between benign and malignant conditions 4.
- High-resolution and color Doppler ultrasonography can assess the characteristics of cervical lymph nodes, including shape, echotexture, and vascular pattern, which can aid in diagnosis 5.
Diagnostic Considerations
When evaluating cervical lymphadenopathy, it is essential to consider various factors, including:
- Patient characteristics, such as age and size of the lymph node 6.
- Laboratory tests, including white blood cell count, C-reactive protein, lactate dehydrogenase, and soluble interleukin-2 receptor levels 6.
- The presence of clinical signs of head and neck cancer or other malignancies 2.
- The results of FNAC and biopsy, which can help establish a definitive diagnosis 3, 6.
Diagnostic Tests
The following diagnostic tests may be used to evaluate cervical lymphadenopathy:
- Biopsy and histological examination of the lymph node 2, 6.
- Fine needle aspiration cytology (FNAC) 3.
- Ultrasound (US) and virtual touch imaging quantification (VTIQ) 4.
- High-resolution and color Doppler ultrasonography 5.
- Laboratory tests, including complete blood count, blood chemistry, and infectious disease serologies 6.