Evaluation of the concordance between clinical and ultrasonographic findings in pediatric patients presenting with complaints of lymph node enlargement specialization thesis in pediatrics

Enlargement of lymph nodes ranks among the leading reasons for referral to general pediatric clinics. In this study, 148 patients who presented with complaints of lymph node enlargement were prospectively evaluated at the Department of General Pediatrics, Hacettepe University Faculty of Medicine Children's Hospital, between June 1, 2023, and June 1, 2024. Of these patients, 94 (63.51%) were male and 54 (36.49%) were female, with ages ranging from 8 months to 17 years and a mean age of 7.18±3.68 years. Upon examining the primary complaints of the patients, it was found that 135 (91.21%) presented with swelling in the neck area, while additional symptoms included fever in 18 patients (12.16%). The most palpable lymphadenopathy (LAP) region on physical examination was the anterior cervical area in 76 patients (51.35%), followed by the submandibular region in 61 patients (41.22%). Among the 16 patients with LAP diameter measuring 3 cm and above, malignancy was detected in 4 (25%), whereas malignancy was found in only 2 (1.51%) out of 132 patients with LAP diameter measuring below 3 cm. Among patients diagnosed with a disease based on LAP biopsy histopathological results, 83.33% had a roundness index <2 on ultrasound (US), whereas among those without LAP biopsy or with benign biopsy results, 4.9% had a roundness index <2. While LAP appeared reactive on US in none of the patients diagnosed with a disease based on LAP biopsy, it was reactive in 3.5% of those without LAP biopsy or with benign biopsy results. All patients diagnosed with a disease based on LAP biopsy had a heterogeneous appearance of LAP on US, whereas 9.09% of those without LAP biopsy or with benign biopsy results had a heterogeneous appearance. Among patients diagnosed with a disease based on LAP biopsy, 33.33% showed peripheral vascularity on US, while 4.23% of those without LAP biopsy or with benign biopsy results showed peripheral vascularity. In terms of the correlation between physical examination and US findings, if at least one of the LAPs diagnosed by physical examination was observed on US, it was considered as concordant; otherwise, it was considered as discordant. Accordingly, 89.86% of the patients were considered concordant, while 10.14% were discordant. LAP biopsy was performed on nine (6.08%) out of 148 patients, with three biopsies reported as benign. Among the remaining six patients, diagnoses based on clinical and biopsy histopathological results were tuberculosis, Hodgkin lymphoma, necrotizing granulomatous lymphadenitis, Langerhans cell histiocytosis, capillary hemangioma, and Rosai-Dorfman disease. It was found that 35.81% of the patients had previously visited another healthcare facility with complaints of lymph node enlargement, and among those referred to an external center, 77.35% underwent US examination. It was concluded that while US examination may be helpful in the diagnosis of malignancy in patients with a history, physical examination, or findings suggestive of malignancy, it may not be necessary in the absence of suspicious history or physical examination findings. No patient initially considered benign based on history, physical examination, and US results was found to have malignancy upon follow-up US examination. Therefore, no patient referred for follow-up was diagnosed with malignancy, and all patients diagnosed with malignancy received their diagnoses at the initial visit. Consequently, it was concluded that US examination may not be meaningful in the follow-up of LAP, and follow-up with physical examination alone is sufficient.