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Demographic, clinical and laboratory characteristics for differential diagnosis of peripheral lymphadenopathy (LAP) and the etiologic distribution of LAP in adults; a multicenter, nested case–control study including 1401 patients from Turkey

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Abstract

Peripheral lymphadenopathy (LAP) is an important and common abnormal finding of the physical exam in general medical practice. We aimed to reveal the LAP etiology and demographic, clinical and laboratory variables that may be useful in the differential evaluation of LAP. This multicenter, nested case–control study including 1401 patients between 2014 and 2019 was conducted in 19 tertiary teaching and research hospitals from different regions in Turkey. The ratio of infectious, malign and autoimmune/inflammatory diseases was 31.3%, 5% and 0.3%, respectively. In 870 (62%) of patients had nonspecific etiology. Extrapulmonary tuberculosis (n: 235, 16.8%) was the most frequent cause of LAP. The ratio of infective etiology of LAP was significantly lower in patients older than 65 years-old compared to younger patients with the rate of 66.67% and 83.84%, respectively (p 0.016, OR 0.386, 95% Cl 0.186–0.803). The probability of malign etiology was higher both in patients who are older than 45 years-old (p < 0.001, OR 3.23, 95% Cl 1.99–5.26) and older than 65 years-old (p 0.002, OR 3.36, 95% Cl 1.69–6.68). Age, localization and duration of LAP, leukocytosis, anemia, thrombocytopenia, CRP and sedimentation rate were important parameters to differentiate infections. Size of lymph node and splenomegaly in addition to the parameters above were useful parameters for differentiating malign from benign etiology. Despite the improvements in diagnostic tools, reaching a definite differential diagnosis of lymphadenopathy is still challenging. Our results may help clinicians to decide in which cases they need an aggressive workup and set strategies on optimizing the diagnostic approach of adulthood lymphadenopathy.

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All data generated or analyzed during this study are included in this published article.

References

  1. Freeman AM, Matto P. Adenopathy (2020) In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513250/. Updated 2020 Jul 10

  2. Gaddey HL, Riegel AM (2016) Unexplained lymphadenopathy: evaluation and differential diagnosis. Am Fam Physician 94(11):896–903

    PubMed  Google Scholar 

  3. Prudent E, La Scola B, Drancourt M, Angelakis E, Raoult D (2018) Molecular strategy for the diagnosis of infectious lymphadenitis. Eur J Clin Microbiol Infect Dis 37(6):1179–1186. https://doi.org/10.1007/s10096-018-3238-2

    Article  PubMed  Google Scholar 

  4. Monaco SE, Khalbuss WE, Pantanowitz L (2012) Benign non-infectious causes of lymphadenopathy: a review of cytomorphology and differential diagnosis. Diagn Cytopathol 40(10):925–938. https://doi.org/10.1002/dc.21767

    Article  PubMed  Google Scholar 

  5. Mohan A, Reddy MK, Phaneendra BV, Chandra A (2007) Aetiology of peripheral lymphadenopathy in adults: analysis of 1724 cases seen at a tertiary care teaching hospital in southern India. Natl Med J India 20(2):78–80

    PubMed  Google Scholar 

  6. Qadri SK, Hamdani NH, Besina S, Makhdoomi R, Rasool R et al (2016) Cytological study of cervical lymphadenopathy in a trtiary care institution from Kashmir Valley. India J Cytol Histol 7:418. https://doi.org/10.4172/2157-7099.1000418

    Article  Google Scholar 

  7. Al-Tawfiq JA, Raslan W (2012) The analysis of pathological findings for cervical lymph node biopsies in eastern Saudi Arabia. J Infect Public Health 5(2):140–144. https://doi.org/10.1016/j.jiph.2011.11.006

    Article  PubMed  Google Scholar 

  8. Gul M, Aliosmanoglu I, Turkoglu A, Dal S, Tas I, Bac B (2013) Peripheral lymphadenopathy in adults: results of 67 cases of excisional biopsy. Dicle Med J 40(2):245–249. https://doi.org/10.5798/diclemedj.0921.2013.02.0263

    Article  Google Scholar 

  9. Ashfaq M, Ahmad N, Ullah I, Iqbal MJ (2006) Cervical lymphadenopathy: diagnostic approach. J Postgrad Med Inst 20(4):374–378

    Google Scholar 

  10. Mert A, Tabak F, Ozaras R, Tahan V, Oztürk R, Aktuğlu Y (2002) Tuberculous lymphadenopathy in adults: a review of 35 cases. Acta Chir Belg 102(2):118–121. https://doi.org/10.1080/00015458.2002.11679277

    Article  CAS  PubMed  Google Scholar 

  11. Golden MP, Vikram HR (2005) Extrapulmonary tuberculosis: an overview. Am Fam Physician 72(9):1761–1768

    PubMed  Google Scholar 

  12. Lee Y, Terry R, Lukes RJ (1980) Lymph node biopsy for diagnosis: a statistical study. J Surg Oncol 14(1):53–60. https://doi.org/10.1002/jso.2930140108

    Article  CAS  PubMed  Google Scholar 

  13. Khajanchi M, Bambarkar S, Gadgil A, Roy N (2016) Cervical node tuberculosis in adults of an urban middle class community: incidence and management. Indian J Otolaryngol Head Neck Surg 68(3):345–351. https://doi.org/10.1007/s12070-015-0832-9

    Article  PubMed  Google Scholar 

  14. Fijten GH, Blijham GH (1988) Unexplained lymphadenopathy in family practice. An evaluation of the probability of malignant causes and the effectiveness of physicians’ workup. J Fam Pract 27(4):373–376. https://doi.org/10.1080/09503158808416945

    Article  CAS  PubMed  Google Scholar 

  15. Darnal HK, Karim N, Kamini K, Angela K (2005) The profile of lymphadenopathy in adults and children. Med J Malays 60(5):590–598

    CAS  Google Scholar 

  16. Özkan EA, Göret CC, Özdemir ZT, Yanık S, Göret NE, Doğan M, Cihan FG, Akkoca AN (2015) Evaluation of peripheral lymphadenopathy with excisional biopsy: six-year experience. Int J Clin Exp Pathol 8(11):15234–15239

    PubMed  PubMed Central  Google Scholar 

  17. Shrestha AL, Shrestha P (2018) Peripheral lymph node excisional biopsy: yield, relevance, and outcomes in a remote surgical setup. Surg Res Pract 2018:8120390. https://doi.org/10.1155/2018/8120390

    Article  PubMed  PubMed Central  Google Scholar 

  18. Ferrer RL (2020) Evaluation of peripheral lymphadenopathy in adults. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. Accessed on 25 Nov 2020

  19. Jung W, Trümper L (2008) Differenzialdiagnose und -abklärung von Lymphknotenvergrösserungen [Differential diagnosis and diagnostic strategies of lymphadenopathy]. Der Internist 49(3):305–320. https://doi.org/10.1007/s00108-008-2016-0

    Article  CAS  PubMed  Google Scholar 

  20. Walsh R, Kornguth PJ, Soo MS, Bentley R, DeLong DM (1997) Axillary lymph nodes: mammographic, pathologic, and clinical correlation. AJR Am J Roentgenol 168(1):33–38. https://doi.org/10.2214/ajr.168.1.8976915

    Article  CAS  PubMed  Google Scholar 

  21. Pangalis GA, Vassilakopoulos TP, Boussiotis VA, Fessas P (1993) Clinical approach to lymphadenopathy. Semin Oncol 20(6):570–582

    CAS  PubMed  Google Scholar 

  22. Watson J, Salisbury C, Banks J, Whiting P, Hamilton W (2019) Predictive value of inflammatory markers for cancer diagnosis in primary care: a prospective cohort study using electronic health records. Br J Cancer 120(11):1045–1051. https://doi.org/10.1038/s41416-019-0458-x

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Sultan Abdulhamid Han Training and Research Hospital, 34668, Uskudar, Istanbul, Turkey

    Ercan Yenilmez, Ayca Ilbak, Ersin Tural & Rıza Aytac Cetinkaya

  2. Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey

    Yıldız Verdi & Ilyas Dokmetas

  3. Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey

    Burcu Caliskan Demirkiran & Zehra Karacaer

  4. Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey

    Zehra Duman

  5. Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey

    Fatma Bozkurt & Muzeyyen Ay

  6. Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey

    Derya Seyman

  7. Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey

    Ali Asan & Cinar Ozturk

  8. Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Adana City Hospital, Adana, Turkey

    Halime Betul Sahin Eker

  9. Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Harran University, Sanliurfa, Turkey

    Mehmet Resat Ceylan

  10. Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Prof. Dr. Cemil Tascıoglu City Hospital, Istanbul, Turkey

    Salih Emre

  11. Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Kartal Lutfi Kirdar City Hospital, Istanbul, Turkey

    Gozde Ozturk Altunyurt

  12. Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey

    Saliha Ayan

  13. Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ataturk University, Erzurum, Turkey

    Emine Parlak

  14. Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Dr. Abdurrahman Yurtaslan Ankara Onkoloji Training and Research Hospital, Ankara, Turkey

    Goknur Yapar Toros

  15. Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, İstanbul Training and Research Hospital, Istanbul, Turkey

    Gulsen Yoruk

  16. Department of Infectious Diseases and Clinical Microbiology, Bakircay University, Cigli Training and Research Hospital, Izmir, Turkey

    Mehmet Ceylan

  17. Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Mehmet Akif Inan Training and Research Hospital, Sanliurfa, Turkey

    Leman Karaagac

  18. Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Fethi Sekin City Hospital, Elazığ, Turkey

    Muge Ozguler

  19. Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey

    Busra Meral

  20. Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey

    Sukran Kose

Authors
  1. Ercan Yenilmez
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  2. Yıldız Verdi
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  3. Ayca Ilbak
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  4. Burcu Caliskan Demirkiran
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  5. Zehra Duman
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  6. Fatma Bozkurt
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  7. Derya Seyman
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  8. Ali Asan
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  9. Halime Betul Sahin Eker
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  10. Mehmet Resat Ceylan
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  11. Salih Emre
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  12. Gozde Ozturk Altunyurt
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  13. Saliha Ayan
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  14. Emine Parlak
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  15. Goknur Yapar Toros
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  16. Gulsen Yoruk
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  17. Mehmet Ceylan
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  18. Leman Karaagac
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  19. Muge Ozguler
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  20. Busra Meral
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  21. Muzeyyen Ay
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  22. Cinar Ozturk
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  23. Zehra Karacaer
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  24. Ersin Tural
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  25. Rıza Aytac Cetinkaya
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  26. Ilyas Dokmetas
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  27. Sukran Kose
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Contributions

All authors contributed the multicenter study, read and approved the final manuscript.

Corresponding author

Correspondence to Ercan Yenilmez.

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The authors declare that they have no conflict of interest.

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The study was approved by the Institutional Ethics Committee of the Health Sciences University, Istanbul (28 03.2020, 20/78).

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Yenilmez, E., Verdi, Y., Ilbak, A. et al. Demographic, clinical and laboratory characteristics for differential diagnosis of peripheral lymphadenopathy (LAP) and the etiologic distribution of LAP in adults; a multicenter, nested case–control study including 1401 patients from Turkey. Intern Emerg Med 16, 2139–2153 (2021). https://doi.org/10.1007/s11739-021-02683-2

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