19, 20 False-positive diagnoses are rare with FNA. However, the use of both techniques may not be needed because the diagnostic accuracy of FNA in adult populations has been reported to approach 90%, with a sensitivity and specificity of 85% to 95% and 98% to 100%, respectively. Combined, they allow cytologic and histopathologic assessment of lymph nodes. 18 If a reactive lymph node is likely, core needle biopsy can be avoided, and FNA used alone. FNA cytology is a quick, accurate, minimally invasive, and safe technique to evaluate patients and aid in triage of unexplained lymphadenopathy. Rheumatoid arthritis, Sjögren syndrome, dermatomyositis, systemic lupus erythematosusĪntinuclear antibody, anti-doubled-stranded DNA, erythrocyte sedimentation rate, CBC, rheumatoid factor, creatine kinase, electromyography, or muscle biopsy as indicatedįine-needle aspiration (FNA) and core needle biopsy can aid in the diagnostic evaluation of lymph nodes when etiology is unknown or malignant risk factors are present ( Table 4 4, 6, 10 ). Serology and testing as indicated by suspected exposureĪrthralgias, rash, joint stiffness, fever, chills, muscle weakness Rabbits, or sheep or cattle wool, hair, or hides HIV-1/HIV-2 immunoassay, rapid plasma reagin, culture of lesions, nucleic acid amplification for chlamydia, migration inhibitory factor test Limited illnesses may not require any additional testing depending on clinical assessment, consider CBC, monospot test, liver function tests, cultures, and disease-specific serologies as neededĬhancroid, HIV infection, lymphogranuloma venereum, syphilis Leukemia, lymphoma, solid tumor metastasisĬBC, nodal biopsy or bone marrow biopsy imaging with ultrasonography or computed tomography may be considered but should not delay referral for biopsyįever, chills, malaise, sore throat, nausea, vomiting, diarrhea no other red flag symptomsīacterial or viral pharyngitis, hepatitis, influenza, mononucleosis, tuberculosis (if exposed), rubella Corticosteroids have limited usefulness in the management of unexplained lymphadenopathy and should not be used without an appropriate diagnosis.įever, night sweats, weight loss, or node located in supraclavicular, popliteal, or iliac region, bruising, splenomegaly Antibiotics may be used to treat acute unilateral cervical lymphadenitis, especially in children with systemic symptoms. Biopsy options include fine-needle aspiration, core needle biopsy, or open excisional biopsy. The workup may include blood tests, imaging, and biopsy depending on clinical presentation, location of the lymphadenopathy, and underlying risk factors. Palpable supraclavicular, popliteal, and iliac nodes are abnormal, as are epitrochlear nodes greater than 5 mm in diameter.

Risk factors for malignancy include age older than 40 years, male sex, white race, supraclavicular location of the nodes, and presence of systemic symptoms such as fever, night sweats, and unexplained weight loss. Generalized lymphadenopathy, defined as two or more involved regions, often indicates underlying systemic disease. Patients with localized lymphadenopathy should be evaluated for etiologies typically associated with the region involved according to lymphatic drainage patterns. When the cause is unknown, lymphadenopathy should be classified as localized or generalized. The history and physical examination alone usually identify the cause of lymphadenopathy. Etiologies include malignancy, infection, and autoimmune disorders, as well as medications and iatrogenic causes. Lymphadenopathy is benign and self-limited in most patients.

Swollen lymph nodes back of neck