Lymphadenopathy in children and adolescents: role of fine-needle aspiration in management.

This study was undertaken to assess the role of fine-needle aspiration biopsy in the evaluation of palpable peripheral lymphadenopathy in pediatric and adolescent patients. A 15-year experience in aspiration of patients younger than age 21 was reviewed. These cases were taken from four large university hospitals and clinics. Data included clinical information, anatomic site, cytologic diagnosis, and any follow-up surgical excision at these institutions. From a total of 1,302 lymph node fine-needle aspirates, a subset of 106 aspirates from patients 21 years or younger was selected. This group formed the basis for this study, and these aspirates were obtained from 103 patients. Most of these aspirates (88.7%) were from the head and neck; 11 were from sites other than head and neck; and the site was not stated in one case. One hundred and one of the aspirates produced adequate samples, and only five (4.72%) were unsatisfactory. Of the 106 fine-needle aspirates, 88 (83.0%) were diagnosed as negative for malignancy, five (4.7%) were inconclusive, and three (2.8%) were interpreted as suspicious but not diagnostic of malignancy. Five cases (4.7%) were diagnosed as positive for malignancy, including two cases of metastatic papillary carcinoma of the thyroid, two cases of Hodgkin's disease, and a single case of high-grade non-Hodgkin's lymphoma. No false-positive or false-negative diagnoses occurred, excluding the aspirates classified as inconclusive or suspicious but not diagnostic of malignancy (six cases). Results of aspirates from near adolescent and adolescent patients (ages 11-21 years) were compared with those of younger pediatric patients (age < 10 years). Eighty-one (76%) of the 106 aspirates were obtained from the older group. The percentage of unsatisfactory specimens was smaller and the percentage of inconclusive or suspicious or malignant diagnoses was greater in the older group. Fine-needle aspiration biopsy is reliable in the evaluation of palpable peripheral lymphadenopathy. As most fine-needle aspirates in children and adolescents proved to indicate benign reactive conditions that failed to respond to antibiotics rather than proving to be malignant tumors, we advocate a larger role for the fine-needle aspiration biopsy technique in the evaluation of peripheral lymphadenopathy in this age group. Its early use can direct further testing, saving time, expense, and morbidity for the patient and reducing anxiety for the parents.