From the Guidelines
In a 31-year-old with palpable lymph nodes in the left elbow area, the chances of these being benign are quite high, approximately 80-90%. Most palpable lymph nodes in young adults are reactive, meaning they're temporarily enlarged due to infection, inflammation, or minor injury in the arm or hand 1. Common benign causes include recent cuts, infections, insect bites, or even vigorous exercise affecting the arm. Concerning features that would lower the likelihood of benign etiology include nodes that are very firm, fixed to surrounding tissue, rapidly growing, larger than 2cm, or accompanied by unexplained weight loss, fever, or night sweats.
Key Considerations
- If the lymph node has been present for less than 2-4 weeks, observation is reasonable as many reactive nodes resolve spontaneously 1.
- However, if the node persists beyond 4-6 weeks, grows larger, or is accompanied by concerning symptoms, medical evaluation is recommended.
- Ultrasound is typically the first imaging study if needed, and occasionally a biopsy may be required for definitive diagnosis if the node remains suspicious 1.
- The National Comprehensive Cancer Network (NCCN) guidelines recommend a complete clinical evaluation to assess for other sites of adenopathy and potential non-breast etiologies of adenopathy, and age-appropriate diagnostic imaging if no systemic disease is found 1.
Diagnostic Approach
- For individuals under 30 years of age, ultrasound is recommended as the initial imaging study 1.
- For those 30 years of age or older, ultrasound with mammogram is recommended 1.
- If the core needle biopsy results indicate malignancy of breast origin in the axillary lymph node but no breast abnormality is evident with ultrasound or mammogram, the panel recommends performing MRI and then following the NCCN Guidelines for Breast Cancer as needed for management of the axillary mass 1.
From the Research
Lymph Node Enlargement
The enlargement of lymph nodes can be caused by various factors, including infection, autoimmune disorders, and malignancy.
- In most cases, lymphadenopathy is benign and self-limited 2.
- The history and physical examination alone usually identify the cause of lymphadenopathy 2.
Risk Factors for Malignancy
Certain factors increase the risk of malignancy in patients with lymphadenopathy, including:
- Age older than 40 years 2
- Male sex 2
- White race 2
- Supraclavicular location of the nodes 2
- Presence of systemic symptoms such as fever, night sweats, and unexplained weight loss 2
Evaluation of Lymphadenopathy
The evaluation of lymphadenopathy typically involves:
- Classification as localized or generalized 2
- Evaluation for etiologies associated with the region involved according to lymphatic drainage patterns 2
- Blood tests, imaging, and biopsy depending on clinical presentation, location of the lymphadenopathy, and underlying risk factors 2, 3
Benign vs. Malignant Lymphadenopathy
In a study of 220 patients who underwent lymph node excisional biopsy, 40.5% had benign lesions, while 59% had malignant diagnoses 3.
- Another study reported a case of microcystic adnexal carcinoma with distant metastasis to the elbow and axillary lymph nodes 4.
- A case report of a 31-year-old woman with unidirectional axillary lymph node swelling was diagnosed with Kikuchi-Fujimoto lymphadenitis, a rare cause of feverish lymphadenitis 5.
Predictive Model for Biopsy
A predictive model was developed to differentiate patients whose biopsy results do not lead to treatment from those whose biopsy results do lead to treatment, based on lymph node size, history of recent ear, nose, and throat symptoms, and chest roentgenogram 6.
- This model can help select adolescents and young adults with peripheral lymphadenopathy for biopsy 6.
Chances of Benign Lymphadenopathy
Given the patient's age (31 years) and the location of the lymph nodes (elbow), it is possible that the lymphadenopathy is benign, especially if there are no systemic symptoms or other risk factors for malignancy 2, 6.