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.

The validation of an algorithm for the management of paediatric cervical lymphadenopathy.
Locke R, MacGregor F, Kubba H.
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Patrick Spielmann

NHS Tayside/University of Dundee, UK.

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