From the Guidelines
No cervical lymphadenopathy is a normal physical examination finding, indicating no abnormal enlargement of the lymph nodes in the neck region, which is generally a reassuring sign as it reduces the likelihood of infection, inflammation, or malignancy. This finding is documented by healthcare providers after palpating the anterior cervical chain, posterior cervical chain, and submandibular areas to assess lymph node size, tenderness, mobility, and consistency, as outlined in the clinical practice guideline for the evaluation of the neck mass in adults 1. According to this guideline, many adults develop an inflammatory neck mass associated with viral or bacterial respiratory infections, but such inflammatory cervical lymphadenopathy is most often self-limited, resolving within weeks.
When interpreting this finding, it is essential to consider the patient's overall clinical picture and other examination findings, as the absence of cervical lymphadenopathy does not rule out other conditions. The guideline also highlights that about half of all adult neck masses are malignant, and a malignant neck mass in an adult is most often due to head and neck cancer, but can also be due to lymphoma, thyroid cancer, salivary gland malignancy, skin cancer, or metastasis from distant sites 1.
In the context of evaluating a neck mass, the clinical practice guideline recommends a thorough examination, including palpation of the lymph nodes, and consideration of the patient's symptoms, such as tachycardia, and other symptoms specific to head and neck infections, as outlined in the guideline 1. The absence of cervical lymphadenopathy should be interpreted with caution, and further evaluation should be considered if there are any suspicious symptoms or findings, as reactive cervical lymphadenopathy commonly occurs with respiratory infection, and such lymphadenopathy typically resolves with the infectious symptoms or within a few days of completing treatment 1.
From the Research
Cervical Lymphadenopathy
- The absence of cervical lymphadenopathy does not necessarily rule out underlying conditions, as lymphadenopathy can be benign and self-limited in most patients 2.
- Etiologies of lymphadenopathy include malignancy, infection, and autoimmune disorders, as well as medications and iatrogenic causes 2, 3, 4.
- The history and physical examination alone usually identify the cause of lymphadenopathy, and when the cause is unknown, lymphadenopathy should be classified as localized or generalized 2.
- Patients with localized lymphadenopathy should be evaluated for etiologies typically associated with the region involved according to lymphatic drainage patterns 2.
- Risk factors for malignancy include age older than 40 years, male sex, white race, supraclavicular location of the nodes, and presence of systemic symptoms such as fever, night sweats, and unexplained weight loss 2, 5.
Evaluation and Diagnosis
- The workup may include blood tests, imaging, and biopsy depending on clinical presentation, location of the lymphadenopathy, and underlying risk factors 2, 5.
- Biopsy options include fine-needle aspiration, core needle biopsy, or open excisional biopsy 2.
- A methodological approach to lymphadenopathy can disclose the accurate diagnosis causing minimal discomfort for the patient and in a short time 3.
- Laboratory parameters significantly associated to malignancies were CRP, LDH and thrombocytopenia 5.
Management
- Antibiotics may be used to treat acute unilateral cervical lymphadenitis, especially in children with systemic symptoms 2.
- Corticosteroids have limited usefulness in the management of unexplained lymphadenopathy and should not be used without an appropriate diagnosis 2.
- Patients with persisting cervical lymphadenopathy and over 3 weeks of antibiotic treatment should be considered for early biopsy, especially if some of the risk factors are present 5.