title: Evaluation of cervical lymphadenopathy in children: advantages and drawbacks of diagnostic methods.
abstract: BACKGROUND
  Cervical lymphadenopathy (LAP) in children is a common clinical diagnostic dilemma. The aim of our study was to analyse ultrasonography, fine needle aspiration biopsy, size and location on the neck to distinguish lymph nodes requiring excision from those that do not.
  
  
  METHODS
  We retrospectively studied 43 cervical lymph nodes that were excised from 43 children aged 0-16 years. We studied the histology of the removed lymph nodes and compared them in terms of size, location, ultrasonography and fine needle aspiration biopsy. Patients were divided into four groups: reactive, malignant, granuloma and other.
  
  
  RESULTS
  The cause of LAP was reactive in 30 patients (70%), malignant in five (12%) and granulomatous in six (14%) of the surgically removed lymph nodes. Size, age and ultrasonographic findings were not correlated with a higher risk of malignancy. However, the risk of malignancy was significantly higher when the LAP was located in the supraclavicular region than in other cervical regions (p = 0.008). Fine needle aspiration biopsy was made preoperatively in 27 cases (63%) and revealed five (19%) nodes to be malignant and 18 (67%) to be due to a reactive cause. The positive predictive value for benign and malignant cause was 91.3% and 75% (p = 0.01), respectively.
  
  
  CONCLUSIONS
  We recommend excisional biopsy if LAP is suspected to be malignant or is located in the supraclavicular region. In case of chronic LAP with no obvious infectious cause or suspected mycobacteria, we recommend fine needle aspiration biopsy as a diagnostic tool. Clinical control and diagnosing of children with LAP should lie in few, skilled hands.
  
  
  BACKGROUND
  not relevant.
  
  
  BACKGROUND
  not relevant.
authors.affiliation: Ear, Nose & Throat Department, Gentofte Hospital. harpa_naria@hotmail.com
authors.forename: Maria
authors.initials: M
authors.lastname: Ingolfsdottir
authors.forename: Viggo
authors.initials: V
authors.lastname: Balle
authors.forename: Christoffer Holst
authors.initials: CH
authors.lastname: Hahn
mesh_terms: D000293:Adolescent; D044963:Biopsy, Fine-Needle; D002648:Child; D002675:Child, Preschool; D005260:Female; D006099:Granuloma / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D007239:Infections / Q000150:complications / Q000175:diagnosis*; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology*; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology*; D008297:Male; D009333:Neck; D009369:Neoplasms / Q000150:complications / Q000175:diagnosis*; D012189:Retrospective Studies; D014463:Ultrasonography