Evaluation of clinical, laboratory and demographic characteristics of childhood lymphadenopathy cases

Objective: In this study, we aimed to show the place of lymphadenopathy, a common cause of hospital admission, in the differential diagnosis of lymphadenopathy, in the differentiation of infectious/non-infectious, benign/malignant, by retrospectively examining the demographic, clinical and laboratory characteristics of the cases. Material and Methods: Our study included 404 cases aged between 1 month and 18 years, who were admitted to the outpatient clinics of Bezmialem Vakıf University, Department of Pediatrics between 01.01.2019 and 31.12.2019 within a year, with a preliminary diagnosis of lymphadenopathy, examination and treatment. From the electronic file records of the cases, the age, gender, history characteristics of the patients, physical examination, complete blood counts, neutrophil/lymphocyte ratios (NLR), mean platelet volume (MPV), CRP, ESR, tests for bacterial and viral diagnosis, imaging results and, if performed, biopsy results were recorded. IBM SPSS 23.0 program was used in the analysis of the data. While evaluating the study data, frequency distribution (number, percentage) for categorical variables and descriptive statistics (mean, standard deviation, minimum, maximum) for numerical variables were used. Independent sample t-test was used to evaluate whether there was a difference between the two groups, and chi-square analysis was used to examine the relationship between two categorical variables Results: The files of 404 patients who were examined with the pre-diagnosis of lymphadenopathy were analyzed. Branchial cleft cyst was detected in one case. Of 403 cases diagnosed with lymphadenopathy, 256 (63.5%) were male and 147 (36.5%) were female. Their ages ranged from 3 months to 17.5 years, with a mean of 6.08±3.964 years. 397 (98.5%) of the cases were benign, 6 (1.5%) were malignant, and in the classification of benign cases among themselves; 240 (59.5%) cases were infectious LAP, 157 (39%) were non-infectious LAP. When the infectious LAP group was evaluated within itself, 205 (50.9%) of 240 cases were in the group whose specific etiology could not be distinguished, viral in 32 (7.9%) cases and bacterial in 3 (0.7%) cases. Of the cases, 304 (75.4%) were acute and 99 (24.6%) were chronic. In the benign group, 299 (75.3%) were acute, 98 (24.7%) were chronic; In the malignant group, 5 (83.3%) were acute and 1 (16.7%) chronic lymphadenopathy. It was determined that the most common cervical region was 69% in regional LAP cases, and cervical and submandibular region coexistence was the most common 55.7% in diffuse LAP cases. EBV in 26 cases, CMV in 7 cases, mumps virus in 3 cases, AGBHS in 2 cases, parvovirus in 1 case, mycoplasma in 1 case, and B.hensalae in 1 case were detected. Although TST was performed in 4 cases, only 1 case was positive. In the ultrasound imaging performed in 208 cases, 194 cases (93.3%) were evaluated as having fatty hiluses, and 14 cases (6.7%) as having non-obvious fatty hiluses. 5 (35.7%) of 14 cases were in the malignant group and 9 (64.3%) were in the benign LAP group. High ESR, neutrophilia, thrombocytosis, high NLR rate in infectious LAP cases were found to be statistically significantly higher than in non-infectious LAP cases. There was no significant relationship between MPV value and demographic, clinical and laboratory findings. No statistically significant data could be found that MPV can be used in the differential diagnosis of acute/chronic, regional/disseminated, infectious/non-infectious, malignant/benign LAP. CRP and ESR values were found to be statistically significantly higher in LAP cases with high NLR. NLR was significantly higher in the infectious LAP group, while the rate of using antibiotics and using antibiotics for more than 1 week was found to be statistically significantly higher in the group with high NLR. Conclusion: In our study, it was shown that lymphadenopathy cases were more common in males. In our cases, acute LAP, benign LAP, cervical and submandibular regional LAP were more common. ESR, thrombocytosis, neutrophilia and NLR were found to be useful biomarkers in the differential diagnosis of infectious and non-infectious LAP. A statistically significant correlation was found between high NLR value and leukocytosis, high CRP, high ESR, rate and duration of antibiotic use. NLR can be a marker in the differential diagnosis of LAP to distinguish between infectious and non-infectious groups. For the differential diagnosis of malignant/benign LAP, we think that more comprehensive studies with a high number of malignant LAP cases may be useful. It was shown that MPV value was not different in acute/chronic, regional/diffuse, infectious/non-infectious, benign/malignant LAP groups, and there was no statistically significant correlation with clinical and laboratory findings. Keywords: lymphadenopathy, lymphadenitis, LAP, benign LAP, malignant LAP