Ultrasound versus fine needle aspiration for the initial evaluation of pediatric cervical lymphadenopathy-A systematic review

Joshua A Thompson; Dylan Bertoni; Julianna Decuzzi; Amal Isaiah; Kevin D Pereira

doi:10.1016/j.ijporl.2023.111485

Ultrasound versus fine needle aspiration for the initial evaluation of pediatric cervical lymphadenopathy-A systematic review

Int J Pediatr Otorhinolaryngol. 2023 Mar:166:111485. doi: 10.1016/j.ijporl.2023.111485. Epub 2023 Feb 10.

Authors

Joshua A Thompson¹, Dylan Bertoni¹, Julianna Decuzzi¹, Amal Isaiah², Kevin D Pereira³

Affiliations

¹ Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
² Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
³ Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA. Electronic address: Kpereira@som.umaryland.edu.

PMID: 36812785
DOI: 10.1016/j.ijporl.2023.111485

Abstract

Objective: Cervical lymphadenopathy is a frequent finding in children that poses diagnostic challenges. We sought to compare the utility of fine needle aspiration (FNA) with ultrasound (US) for evaluating pediatric cervical lymphadenopathy based on published literature.

Study design: In October 2019, we performed a comprehensive electronic search of PubMed, OVID (MEDLINE), EMBASE, and Scopus databases. Two authors independently screened and assessed full-text reports of potentially eligible studies. We compared sensitivity, specificity, positive predictive value estimates, and balanced accuracy for determining the underlying etiology of lymphadenopathy.

Results: The initial search returned 7736 possible studies, of which 31 met the criteria for inclusion. A total of 25 studies were included in the final analysis, with a total of 4721 patients, of which 52.8% were male. Of these, 9 (36.0%) examined US, and 16 (64%) examined fine needle aspiration. The pooled balanced accuracy for determining etiology was 87.7% for US and 92.9% for FNA. Reactive lymphadenopathy was identified in 47.9%, 9.2% were malignant, 12.6% were granulomatous, and 6.6% were non-diagnostic.

Conclusions: In this systematic review, US was identified as an accurate initial diagnostic imaging modality in children. Fine needle aspiration was found to play a significant role in ruling out malignant lesions and potentially avoiding excisional biopsy.

Keywords: Cervical lymphadenopathy; Diagnostic performance; Fine needle aspiration; Systematic review; Ultrasound.

Publication types

Systematic Review

MeSH terms

Biopsy, Fine-Needle / methods
Child
Female
Humans
Lymphadenopathy*
Male
Predictive Value of Tests
Sensitivity and Specificity
Ultrasonography