Background: Lymphadenopathy imposes a diagnostic challenge in internal medicine. Exclusion of malignancy is the primary concern.
Methods: A retrospective case series, including 40 consecutive adult patients from a general internal medicine department who underwent lymph node biopsy (LNB) at a single university hospital. Demographics, clinical data and histopathological diagnoses were registered. By means of the latest medical record, we obtained a final diagnosis for each patient and subsequently searched for variables correlated with malignancy. Follow-up was at least one year in 95% of cases.
Results: the prevalence of malignancy was 58%. Older age (p=0.02) and low hemoglobin concentration (p=0.05) were significantly correlated with malignancy. The presence of fever > 38°C (p=0.05) and painful lymphadenopathy at clinical examination (p=0.02) were significantly associated with a benign outcome. No single or combination of baseline variables satisfactorily excluded malignancy. Histopathological analysis correctly predicted malignancy in 93% of cases. In two cases, an initial diagnosis of benign nonspecific lymphadenopathy was reversed to non Hodgkin lymphoma. In one case the pathological diagnosis was inconclusive.
Conclusion: Rather than following a universal algorithm to determine the need for LNB in patients with LA, we call for individualized decision-making in each case, carefully appreciating all available information. Additionally, one should keep in mind that false negative results occur due to sampling errors. Therefore, a minimal number of cases should end in a final diagnosis of benign non-specific lymphadenopathy. Intensive, multidisciplinary cooperation with surgeon and pathologist is needed. Moreover, clinical follow-up should be at least one year.