Use of Ultrasound (US) in the assessment of children with cervical lymphadenopathy
Date First Published:
June 27, 2011
Last Updated:
July 7, 2011
Report by:
Jannah Radzif, Medical Student (University of Manchester)
Search checked by:
Jannah Radzif, University of Manchester
Three-Part Question:
In [children who present to the ED with cervical lymphadenopathy], is [ultrasound] useful in [helping to make a diagnosis]?
Clinical Scenario:
A 12 year old boy came into the ED brought by his parents who were concern that an enlarged lymph node in the boy's neck has not subsided since it was present about 3 months ago. Initial history and clinical investigations were done. Should the boy undergo ultrasound to further assess the lymphadenopathy?
Search Strategy:
Ovid MEDLINE(R) 1948 to June Week 3 2011 and
Embase 1980 to 2011 Week 25 and
CINAHL
[lymphadenopath$.mp. OR exp Lymph/ OR node$.mp.]
AND
[exp Neck/ or neck.mp. OR cervical.mp. OR anterior triangle.mp. OR posterior triangle.mp. OR lymph nodes.mp. OR exp Lymph Nodes/]
AND
[exp child/ OR child$.mp. OR exp pediatrics/ OR pediatric$.mp. OR paediatric$.mp. OR perinat$.mp. OR neonat$.mp. OR newborn$.mp. OR infan$.mp. OR bab$.mp. OR toddler$.mp. OR boy$.mp. OR girl$.mp. OR kid$1.mp. OR school?age.mp. OR juvenil$.mp. OR under?age$.mp. OR teen$.mp. OR minor$.mp. OR pubescen$.mp. OR adolescen$.mp. OR infan$.jw. OR child$.jw. OR pediatric$.jw. OR paediatric$.jw. OR adolescen$.jw.]
limit to (english language and humans)
Embase 1980 to 2011 Week 25 and
CINAHL
[lymphadenopath$.mp. OR exp Lymph/ OR node$.mp.]
AND
[exp Neck/ or neck.mp. OR cervical.mp. OR anterior triangle.mp. OR posterior triangle.mp. OR lymph nodes.mp. OR exp Lymph Nodes/]
AND
[exp child/ OR child$.mp. OR exp pediatrics/ OR pediatric$.mp. OR paediatric$.mp. OR perinat$.mp. OR neonat$.mp. OR newborn$.mp. OR infan$.mp. OR bab$.mp. OR toddler$.mp. OR boy$.mp. OR girl$.mp. OR kid$1.mp. OR school?age.mp. OR juvenil$.mp. OR under?age$.mp. OR teen$.mp. OR minor$.mp. OR pubescen$.mp. OR adolescen$.mp. OR infan$.jw. OR child$.jw. OR pediatric$.jw. OR paediatric$.jw. OR adolescen$.jw.]
limit to (english language and humans)
Outcome:
2044 papers were found in Medline, 2644 in Embase and 110 results obtained from CINAHL.
Only 4 papers were relevant to the question.
Only 4 papers were relevant to the question.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Usefulness of ultrasonography for the evaluation of cervical lymphadenopathy. Khanna R. et al. 30/06/2011 India | 192 patients with reactive lymph node, tubercular, metastatic or lymphoma underwent ultrasonographic examination followed by FNAC of the most representative lymph node. | Correlation between ultrasonographic findings and tissue diagnosis (FNAC) | Ultrasound is useful when used as an adjunct to FNAC. Ultrasound is useful in distinguishing between normal and abnormal cervical lymph nodes but there is a considerable characteristic overlap between tubercular, metastatic and lymphamatous lymph nodes. | No study sample power calculation. Primary and/or secondary outcome was not stated. It wasn't clear if the same technician conducted the ultrasonographic examination on all patients. Basic data was not adequately described. |
|
| Ultrasonographic evaluation of cervical lymph nodes in Kawasaki disease Tashiro N. et. al 30/06/2011 Japan | Patients who presented with fever and lymphadenopathy (anterior or posterior cervical mass) were included which consists of 22 patients with Kawasaki (KD), 8 with presumed bacterial lymphadenitis and 5 with EBV infectious mononucleosis | Compare ultrasonographic features of cervical lymph nodes in patients with KD, bacterial lymphadenitis and infectious mononucleosis | The ultrasonographic features of KD was similar to infectious mononucleosis but different from bacterial lymphadenitis. | Small sample size. Statistical analysis of outcome was not done. |
|
| The sonographic characteristics of nontuberculous mycobacterial cervicofacial lymphadenitis in children Lindeboom JA. et. al 30/06/2011 The Netherlands | Ultrasonography was performed in 145 children with confirmed non-tuberculous mycobacterium (NTM) cervicofacial lymphadenitis from a large randomized, prospective, multicentre trial (CHIMED) to evaluate the effectiveness of surgery vs medication for NTM cervicofacial lymphadenitis. | Descriptive study | To assess the sonographic findings of NTM cervicofacial lymphadenitis inchildren | There was marked decrease echogenicity in all cases, liquesfaction with intranodal cystc necrosis, nodal matting and adjacent soft-tissue oedema. Multiple intranodal calcifications characteristic of end-stage disease. | No comparison was made with other causes of cervical lymphadenopathy. Only descriptive statistics were used to analyze the data. Small sample size. |
| Role of ultrasonography and computed tomography in complicated cases of tuberculous cervical lymphadenitis. Gupta KB. et. al 30/06/2011 India | 27 patients with tuberculous cervical lymphadenitis taking anti-tuberculosis treatment presenting with big lymph node mass and complications during treatment. | Descriptive study | To evaluate cervical tuberculous lymphadenitis by ultrasonography | All lesions were hypoechoic (100%) and showed necrosis (100%). Sharp margins (70.4%), hilum (22.2%), abnormal surrounding tissue (85.2%), matting (37%), calcification (29.6%) and posterior enhancement (22.2%) | Descriptive analysis only. No statistical analysis. Small sample size. |
Author Commentary:
Most of the papers found on this topic were descriptive ultrasonographic findings of spesific differentials of cervical lymphdenopathy. None actually studied the effectiveness of ultrasound as a diganostic tool. However, from the papers above, it is evident that there are certain characteristics associated with the different differentials that may be of use as an adjunct to clinical history, clinical examination and preliminary investigations in order to reach a diagnosis. More advanced form of US (e.g. US elastography, Doppler US etc) have also been evaluated, however, it was thought to be too specialized to be included in this study as it may not be relevant to the ED.
Bottom Line:
Although evidence are scarce, ultrasound is a useful adjunct to aid in the diagnosis of cervical lymphadenopathy but should not be relied on its own.
References:
- Khanna R. et al.. Usefulness of ultrasonography for the evaluation of cervical lymphadenopathy.
- Tashiro N. et. al. Ultrasonographic evaluation of cervical lymph nodes in Kawasaki disease
- Lindeboom JA. et. al. The sonographic characteristics of nontuberculous mycobacterial cervicofacial lymphadenitis in children
- Gupta KB. et. al. Role of ultrasonography and computed tomography in complicated cases of tuberculous cervical lymphadenitis.