2014 Volume 24 Issue 1 Pages 101-107
Lymph node enlargement is a common manifestation of a variety of inflammatory and malignant diseases, and it is often difficult to make a definitive diagnosis of this state without lymph node biopsy. We retrospectively studied the clinical background of diagnostic biopsies of cervical lymph nodes.
One hundred and fourteen patients with cervical lymph node enlargement who underwent cervical lymph node biopsy during a 7-year period in our department were enrolled. There were 57 men and 57 women ranging in age from 15 to 94 years with an average age of 59.9 years. Medical records were reviewed for the consultation processes, diagnoses, age groups, imaging examinations, blood tests, and FNAC.
Forty-two (36.8%), 61 (53.5%) and 11 (9.6%) patients were eventually diagnosed as having inflammatory, malignant lymphoma and metastatic carcinoma, respectively. The patients' age was higher in the malignant group than in the inflammatory group (p < 0.001). The percentage of malignant diseases was higher in patients aged > 30 years (p < 0.001). CT finding of central necrosis was helpful for diagnosis of metastatic carcinoma. Malignant lymphoma was strongly suspected when the sIL-2R level was > 3000U/mL. The sIL-2R level was correlated with WBC (r = 0.219, p < 0.05), CRP (r = 0.412, p < 0.001), LDH (r = 0.521, p < 0.001), and albumin (r = -0.402, p < 0.001), indicating that the sIL-2R level reflects the state of illness and systemic condition. The percentage of malignant diseases was also higher in class III/IV/V cases than in class I/II cases in FNAC (p < 0.05), but there were still 10 patients with malignant lymphoma in 25 class I/II cases.
These results indicate that cervical lymph node biopsy should be considered to be indicated for patients when malignant lymphoma is strongly suspected based on other clinical examinations. However, the indication of lymph node biopsy should be limited when metastatic malignant tumors are not ruled out.
