Predictability of Chronic and Persistent Lymphadenopathy in Childhood with Ultrasound and Laboratory Data: A Pediatric Hematology-Oncology Outpatient Clinic Experience
Abstract
Aim:
Lymphadenopathies occupy an important part of pediatric hematology-oncology practice. More than 95 per cent of cases are known to be reactive, and infection-related. Lymphadenopathies are followed up at 1-3-6 month intervals, and the process requires ultrasound follow-up. Our study aimed to compare the persistent and non-persistent cases.
Results: In our study, lymphadenopathy cases (n=93) admitted to our pediatric haematology-oncology outpatient clinic between 2022-2023 were examined and diagnosed; reactive lymph nodes (n=76)(81. 7%), infectious mononucleosis (n=9)(9. 7%), tuberculosis (n=1)(1%), lymphoma (n=2)(2%), benign cytology (n=2)(2%). Mean age ± standard deviation (SD); 8. 2±4. 4, number of girls; 42 (45. 2%). The median time to resolution of acute (n=8)(8. 6%), subacute (n=26)(28%), chronic (n=59)(63. 4%) lymphadenopathy was 1 [5-155] week. Cases with and without ultrasonographic disappearance of lymphadenopathy were compared; the mean hemoglobin value (g/dL) (12. 7±1. 4 vs. 12. 3±1. 2, respectively) (p=0. 047) and platelet value (x10³/mm³) (334. 2±108. 012 vs. 288. 4±89. 5, respectively) (p=0. 047) were higher and the presence of hilar vascularity on ultrasonography (76% vs. 98. 1%) (p=0. 001) was LOWER in those who disappeared compared to those who did not disappear. There was no correlation between hypoechoic lymph node, indistinct border, necrosis, fatty hilus, perinodal cortical vascularity, cortical thickening, presence of lymph node in more than one region and non-loss of lymph node.
Conclusion: In conclusion, it has been shown that in the presence of lymphadenopathy, elevated hemoglobin and platelets, together with the presence of hilar vascularity, may be predictive findings in the failure of the lymph node to disappear.
Key words: lymphadenopathy, ultrasonography, haemoglobin, platelets, childhood
References
- Weinstock MS, Patel NA, Smith LP. Pediatric cervical lymphadenopathy. Pediatr Rev. 2018;39(9):433-443.
- Thompson JA, Bertoni D, Decuzzi J, Isaiah A, Pereira KD. Ultrasound versus fine needle aspiration for the initial evaluation of pediatric cervical lymphadenopathy-A systematic review. Int J Pediatr Otorhinolaryngol. 2023;166:111485.
- Harris JE, Patel NN, Wai K, Rosbe KW. Management of pediatric persistent asymptomatic cervical lymphadenopathy. Otolaryngol Head Neck Surg. 2023;7.
- Pandey A, Kureel SN, Pandey J, Wakhlu A, Rawat J, Singh TB. Chronic cervical lymphadenopathy in children: Role of ultrasonography. J Indian Assoc Pediatr Surg. 2012;17(2):58-62.
- Park JE, Ryu YJ, Kim JY, et al. Cervical lymphadenopathy in children: a diagnostic tree analysis model based on ultrasonographic and clinical findings. Eur Radiol. 2020;30(8):4475-4485.
- Riva G, Sensini M, Peradotto F, Scolfaro C, Di Rosa G, Tavormina P. Pediatric neck masses: how clinical and radiological features can drive diagnosis. Eur J Pediatr. 2019;178(4):463-471.
- Alves Rosa J, Calle-Toro JS, Kidd M, Andronikou S. Normal head and neck lymph nodes in the paediatric population. Clin Radiol. 2021;76(4):315.e1-315.e7.
- Meadows O, Sarkodieh J. Ultrasound evaluation of persistent cervical lymph nodes in young children. Clin Radiol. 2021;76(4):315.e9-315.e12.
- Yu TZ, Zhang Y, Zhang WZ, et al. Role of ultrasound in the diagnosis of cervical tuberculous lymphadenitis in children. World J Pediatr. 2021;17,544-550.
- Shadmani G, Don S. What is this bump in my neck? Ultrasonographic evaluation of pediatric neck masses. J Clin Ultrasound. 2023;51(5):919-930.
- Šljivić M, Pšeničny E, Glušič M, Ključevšek D. A pictorial essay on ultrasonography of lymphadenopathies in children. Central Eur J Paediatr. 2023;19(1):13-23.
- Restrepo R, Oneto J, Lopez K, Kukreja K. Head and neck lymph nodes in children: the spectrum from normal to abnormal. Pediatric Radiology. 2009;39(8):836-846.
- Lindeboom JA, Smets AM, Kuijper EJ, van Rijn RR, Prins JM. The sonographic characteristics of nontuberculous mycobacterial cervicofacial lymphadenitis in children. Pediatr Radiol. 2006;36(10):1063-7.
- Páez-Guillán EM, Campos-Franco J, Alende R, Gonzalez-Quintela A. Hematological abnormalities beyond lymphocytosis during ınfectious mononucleosis: epstein-barr virusınduced thrombocytopenia. Mediterr J Hematol Infect Dis. 2023;15(1):e2023023.
- Yenilmez E, Verdi Y, Ilbak A, et al. Demographic, clinical and laboratory characteristics for differential diagnosis of peripheral lymphadenopathy (LAP) and the etiologic distribution of LAP in adults; a multicenter, nested case–control study including 1401 patients from Turkey. Intern Emerg Med. 2021;16:2139-53.
Çocukluk çağı Kronik ve Persistan Lenfadenopatilerin Ultrason ve Laboratuvar Veriler eşliğinde Öngörülebilirliği; Bir Çocuk Hematoloji-Onkoloji Polikliniği Deneyimi
Abstract
Amaç:
Lenfadenopatiler, çocuk hematoloji-onkoloji pratiğinin önemli bir kısmını işgal etmektedir. Yüzde 95'den fazla olgunun, reaktif, enfeksiyon ilişkili olduğu bilinmektedir. Lenfadenopatiler, 1-3-6 ay aralarla takip edilmektedir, ve süreç ultrason takibi gerektirmektedir. Çalışmamızın amacı, laboratuvar ve ultrason bulgularının lenf nodunun normal boyuta inmesini öngören faktörlerin araştırılmasıdır.
Materyal-Metod:
Çalışmamızda, 2022-2023 yılları arasında çocuk hematoloji-onkoloji polikliğimize başvuran lenfadenopati olgular (n=93) incelendi. Normal boyuta ulaşan ve ulaşmamış lenf nodlarının özellikleri karşılaştırıldı.
Sonuçlar:
Tanılar; reaktif lenf nodu (n=76)(%81,7), enfeksiyöz mononükleoz (n=9)(%9,7), tüberküloz (n=1)(%1), lenfoma (n=2)(%2), benign sitoloji (n=2)(%2) idi. Ortalama yaş ± standard sapma (SD); 8.2±4,4, kız sayısı; 42 (%45,2) idi. Akut (n=8)(%8.6), subakut (n=26)(%28), kronik (n=59)(%63,4) lenfadenopatinin ortanca kaybolma süresi 1 [5-155] hafta bulundu. Lenfadenopatinin ultrasonografik kaybolduğu ve kaybolmadığı olgular kıyaslandı; kaybolanlarda, kaybolmayanlara göre ortalama hemoglobin değeri (g/dL)(sırasıyla 12,7±1,4'e 12,3±1,2) (p=0,047) ve trombosit değeri (x10³/mm³) (sırasıyla 334.2±108.012'e 288.4±89.5)(p=0,047) daha yüksek, ultrasonografide hiler vaskülaritenin varlığı (%76'a %98,1)(p=0.001) daha DÜŞÜK oranda istatistiksel anlamlı bulundu. Hipoekoik lenf nodu, sınır belirsizliği, nekroz, yağlı hilus, perinodal kortikal vaskülarite, kortikal kalınlaşma, birden çok bölgede lenf nodu varlığının olması ile lenf nodunun kaybolmaması arasında bir ilişki gösterilemedi.
Sonuç: lenfadenopati varlığında, hemoglobin ve trombosit yüksekliğinin ile hiler vaskülarite varlığı ile birlikte lenf nodunun kaybolmamasında öngörücü bulgular olabileceği gösterilmektedir.
Keywords
References
- Weinstock MS, Patel NA, Smith LP. Pediatric cervical lymphadenopathy. Pediatr Rev. 2018;39(9):433-443.
- Thompson JA, Bertoni D, Decuzzi J, Isaiah A, Pereira KD. Ultrasound versus fine needle aspiration for the initial evaluation of pediatric cervical lymphadenopathy-A systematic review. Int J Pediatr Otorhinolaryngol. 2023;166:111485.
- Harris JE, Patel NN, Wai K, Rosbe KW. Management of pediatric persistent asymptomatic cervical lymphadenopathy. Otolaryngol Head Neck Surg. 2023;7.
- Pandey A, Kureel SN, Pandey J, Wakhlu A, Rawat J, Singh TB. Chronic cervical lymphadenopathy in children: Role of ultrasonography. J Indian Assoc Pediatr Surg. 2012;17(2):58-62.
- Park JE, Ryu YJ, Kim JY, et al. Cervical lymphadenopathy in children: a diagnostic tree analysis model based on ultrasonographic and clinical findings. Eur Radiol. 2020;30(8):4475-4485.
- Riva G, Sensini M, Peradotto F, Scolfaro C, Di Rosa G, Tavormina P. Pediatric neck masses: how clinical and radiological features can drive diagnosis. Eur J Pediatr. 2019;178(4):463-471.
- Alves Rosa J, Calle-Toro JS, Kidd M, Andronikou S. Normal head and neck lymph nodes in the paediatric population. Clin Radiol. 2021;76(4):315.e1-315.e7.
- Meadows O, Sarkodieh J. Ultrasound evaluation of persistent cervical lymph nodes in young children. Clin Radiol. 2021;76(4):315.e9-315.e12.
- Yu TZ, Zhang Y, Zhang WZ, et al. Role of ultrasound in the diagnosis of cervical tuberculous lymphadenitis in children. World J Pediatr. 2021;17,544-550.
- Shadmani G, Don S. What is this bump in my neck? Ultrasonographic evaluation of pediatric neck masses. J Clin Ultrasound. 2023;51(5):919-930.
- Šljivić M, Pšeničny E, Glušič M, Ključevšek D. A pictorial essay on ultrasonography of lymphadenopathies in children. Central Eur J Paediatr. 2023;19(1):13-23.
- Restrepo R, Oneto J, Lopez K, Kukreja K. Head and neck lymph nodes in children: the spectrum from normal to abnormal. Pediatric Radiology. 2009;39(8):836-846.
- Lindeboom JA, Smets AM, Kuijper EJ, van Rijn RR, Prins JM. The sonographic characteristics of nontuberculous mycobacterial cervicofacial lymphadenitis in children. Pediatr Radiol. 2006;36(10):1063-7.
- Páez-Guillán EM, Campos-Franco J, Alende R, Gonzalez-Quintela A. Hematological abnormalities beyond lymphocytosis during ınfectious mononucleosis: epstein-barr virusınduced thrombocytopenia. Mediterr J Hematol Infect Dis. 2023;15(1):e2023023.
- Yenilmez E, Verdi Y, Ilbak A, et al. Demographic, clinical and laboratory characteristics for differential diagnosis of peripheral lymphadenopathy (LAP) and the etiologic distribution of LAP in adults; a multicenter, nested case–control study including 1401 patients from Turkey. Intern Emerg Med. 2021;16:2139-53.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences (Other) |
| Journal Section | Research Article |
| Authors | |
| Publication Date | February 29, 2024 |
| Submission Date | September 14, 2023 |
| Published in Issue | Year 2024 Volume: 2 Issue: 1 |
