Childhood Lymphadenopathy: Ultrasonographic Predictors of Malignancy in a Retrospective Cohort of 500 Patients

Şule Çalışkan Kamış^*Begül Yağcı

• Adana City Training and Research Hospital, Ministry of Health (Turkey), Adana, Türkiye

Pediatric lymphadenopathy is common, yet distinguishing benign from malignant causes remains challenging; objective predictors are needed to refine biopsy decisions. We retrospectively analyzed 500 children (0–18 years) with regional enlarged lymph nodes evaluated at a tertiary pediatric hematology–oncology clinic (June 2024–March 2025). Demographics, node location and size, multiplicity, ultrasonographic (US) assessment, viral tests, biopsy, and bone marrow results were extracted from the hospital system. Associations with definitive diagnosis were tested, and multivariable logistic regression identified independent predictors of malignancy. Median age was 6 years; cervical nodes were most frequent (92.2%), and multiple nodes were present in 93.6%. Biopsy was performed in 47 patients, yielding malignancy in 23 (48.9%). Final diagnoses were reactive lymphadenopathy (87.4%), hematologic malignancy (4.4%), and metastatic solid tumors (1.4%). On univariable analyses, larger size (≥2 cm), multiplicity, and certain regions were associated with malignancy (p<0.05). However, in multivariable analysis only US findings remained independently predictive: nodes categorized as suspicious on US were associated with an approximately 56-fold increase in the odds of malignancy (adjusted OR ≈55.6; 95% CI ≈14.3–200; p<0.001), whereas size and anatomical region were not significant. These data support an ultrasound-centered approach to biopsy referral in childhood lymphadenopathy, potentially reducing unnecessary invasive procedures while maintaining timely detection of malignant disease.