Predictors of Malignant Lymph Node Involvement in paediatric patients: Analysis of 217 Cases

Introduction. Diagnosing cervical lymphadenopathy in children with a history of oncological or immunopathological conditions is challenging, often resulting in overtreatment. This study analyses ultrasound-based differential diagnostics for lymphadenopathy in this patient group. Aim. To improve diagnostic accuracy for cervical lymphadenopathy in children with a history of oncological or immunopathological conditions. Materials and methods . A retrospective analysis was performed on clinical and demographic data from 217 paediatric patients diagnosed with cervical lymphadenopathy. These patients underwent excisional lymph node biopsy and/or lymphadenectomy between December 2017 and December 2022. The cohort was divided into Group A (benign lymphadenopathy; n = 92) and Group B (malignant lymphadenopathy; n = 125). Results. Significant predictors of malignant lymphadenopathy were identified, including “Lymph Node Configuration Index ≤ 2” (increasing the odds by 4.4–5.1 times), “Short Axis of Lymph Node > 10 mm” (OR 2.5–2.8), “Specific Therapy Prior to Lymph Node Removal” (OR 6.9–7.2), “Absence of Lymph Node Differentiation” (OR 2.2–2.4), “Presence of Intranodal Microcalcifications” (OR 14.1–16.3), “Increased Vascularisation of the Lymph Node” (OR 2.0–2.6), “Overall Hypoechogenicity” (OR 2.4), and “Formation of Conglomerates” (OR 3.6). Predictive models integrating these factors demonstrated strong accuracy, with an informational capacity of 81.1% (p < 0.001), sensitivity between 79.3% and 82.6%, and specificity from 80.0% to 82.4%. Discussion. The comprehensive analysis of predictive factors for malignant lymphadenopathy in patients with a history of oncological or immunopathological diseases suggests that no single ultrasound risk factor should be the sole basis for differential diagnosis, supporting earlier findings. Conclusion. The predictive models provide a standardised, robust approach for assessing malignant lymph node involvement, improving diagnostic accuracy in paediatric patients with oncological or immunopathological histories.