The authors present a very helpful algorithm to manage cervical lymphadenopathy in children. The goal of managing children with inflamed lymph glands is to identify the rare malignant case and not over-investigate the vast majority of benign reactive swellings – a careful balance. The authors, working in a tertiary-referral centre, have produced clear evidence-based criteria to direct management and report results of >200 children managed according to it.
The vast majority (85%) were diagnosed as benign / reactive and discharged at the first visit. They had not been re-referred in a five-year follow-up window, vindicating the decision to discharge. Only 2% eventually proceeded to excision biopsy based on the criteria. Although lymphoma would be the expected ‘malignant diagnosis’ not to be missed, no case was identified, the only malignancy being a sarcoma. Having clear evidence-based management criteria is useful for practising clinicians who see such children infrequently and trainees approaching post-graduate exams alike. I would recommend anyone working with children to get hold of the treatment algorithm.