Ingolfsdottir Maria, Balle Viggo, Hahn Christoffer Holst
Ear, Nose & Throat Department, Gentofte Hospital.
Dan Med J. 2013 Aug;60(8):A4667.
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.
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.
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.
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.
not relevant.
not relevant.
儿童颈部淋巴结病是临床常见的诊断难题。本研究旨在分析超声检查、细针穿刺活检、颈部淋巴结大小及位置，以区分需要切除的淋巴结与无需切除的淋巴结。
我们回顾性研究了从43名0至16岁儿童切除的43个颈部淋巴结。我们研究了切除淋巴结的组织学，并在大小、位置、超声检查和细针穿刺活检方面进行了比较。患者分为四组：反应性、恶性、肉芽肿性和其他。
手术切除的淋巴结中，30例（70%）颈部淋巴结病的病因是反应性的，5例（12%）是恶性的，6例（14%）是肉芽肿性的。大小、年龄和超声检查结果与较高的恶性风险无关。然而，当颈部淋巴结病位于锁骨上区域时，恶性风险显著高于其他颈部区域（p = 0.008）。27例（63%）术前进行了细针穿刺活检，其中5例（19%）淋巴结为恶性，18例（67%）为反应性病因。良性和恶性病因的阳性预测值分别为91.3%和75%（p = 0.01）。
如果怀疑颈部淋巴结病是恶性的或位于锁骨上区域，我们建议进行切除活检。对于无明显感染病因或疑似分枝杆菌的慢性颈部淋巴结病，我们建议将细针穿刺活检作为诊断工具。儿童颈部淋巴结病的临床管理和诊断应由少数技术熟练的人员负责。
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