Pathologic lymph node results and the risk factors of malignancy in the patients who presented with cervical lymphadenopathy at Otolaryngology department, Phatthalung hospital

Abstract

              Objective: This study was conducted in order to achieve accuracy diagnosis and the best treatment for the patients who presented with cervical lymphadenopathy. A patient characteristic, age, gender, location of lymph node, size of lymph node, pathological results and the risk factors of malignancy were determined.
              Materials and methods: This is a retrospective descriptive study and the medical record reviewed of 140 patients who underwent cervical lymph node biopsy between the period of January 2010 and May 2017 at Otolaryngology unit, Patthalung hospital. Inclusion criteria is neck node unknown primary or cervical lymphadenopathy, which did not improve after treatment 4 weeks. Data recorded were collected including; gender, age, location and size of lymph node and pathological results. Statistical analysis was performed using the SPSS version 11. A p-value <0.05 was accepted as statistically significant. Categorical variables were presented as percentages.
              Results: A total 140 patients with cervical lymphadenopathy were collected. Females were 53.57% whereas 46.43% were male. According to age group, the common pathological result in a range of 0-15 year-old is reactive hyperplasia (69.57%), the common pathological result in a range of 15-60 year-old is caseous granulomatous (55.56%). In this age group, 4 patients also have positive HIV test and 1 patient has concomitant with diabetes mellitus and the common pathological result in patients who were over 60 year-old is lymphoma (48%). All patients in this age group have negative results of HIV test and just only one patient has concomitant with diabetes mellitus. The risk factors of malignancy are male (risk ratio 2.04), patients over the age of 45 years (50%, risk ratio 5.86). The risk of malignancy when the size of lymph node over 2 cm. (67.44%,risk ratio 9.35). Submandibular area is the most potential location to be the risk of malignancy (80%, risk ratio 3.54) and the most common malignancy cell type is lymphoma. According to the pathological results of cervical lymphadenopathy, caseous granulomatous is the common pathology at cervical, supraclavicular and submental area (39.13%, 52.94 and 100%, respectively). At the submandibular area, lymphoma was found in 80%.
              Conclusion : Cervical lymphadenopathy is the common finding in all age groups and it is the challenging clinical presentations for diagnosing and management. Cervical lymphadenopathy can occur for a number of causes including infection, benign, malignancy, autoimmune, drug induced or iatrogenic. The complete history taking, meticulous physical examination and the risk evaluation are essential for early diagnosing and management of patients who presented with cervical lymphadenopathy. The fundamental data from this study is important and necessary for counseling and planning of the best treatment to the patients who attend in otolaryngology unit at Patthalung hospital. According to pathological results, the most common benign cell type of cervical lymphadenopathy is caseous granulomatous, the most common malignant cell type of cervical lymphadenopathy is lymphoma and the most common cell type in childhood is reactive hyperplasia.