Risk Factors for Malignancy in Subacute or Chronic Cranio-Cervical Lymphadenopathy in Children

Background: Isolated subacute or chronic cranio-cervical lymphadenopathy is a common finding among pediatric patients. Malignant etiology accounts for only a minority of cases; yet its evaluation requires an invasive intervention for definitive diagnosis. Therefore, the aim of this study was to describe the risk-factors for malignancy in these children, in order to aid clinicians in identifying high-risk patients requiring a surgical biopsy and prevent unnecessary surgical interventions in low-risk children.

Methods: Data were retrospectively obtained of children with a diagnosis of isolated subacute (2 to 6 weeks) or chronic (> 6 weeks) lymphadenopathy, from January 2008 to November 2020, at an ambulatory clinic at the Schneider Children`s Medical Center. Univariate and multivariate analyses of risk-factors for malignancy were performed.

Results: During the study period, 450 children at a median age of 4.1 years (IQR= 2.4 – 8.6) were included. Of these, 25 (5.5%) were eventually diagnosed with a malignancy. Factors associated with malignancy by univariate analysis included referral by ENT specialist versus referral by a family physician or pediatrician, patient age, size and location of node, systemic signs, and abnormal imaging studies. However, fever, night sweats, pruritus, and laboratory workup were not. Multivariate analysis identified only two risk-factors for malignancy: patient age and size of lymph node [age>151 months: 19.6% malignancy (CI 9.5%-12.8%; size>31mm: 11.8% malignancy (CI 0.6%-25.3%)].

Conclusion: Patient age and size of a subacute or chronically enlarged cranio-cervical lymph node may aid to identify children at high-risk for malignancy, in whom a surgical intervention should be strongly considered