Etiologies of Pediatric Cervical Lymphadenopathy: A Systematic Review of 2687 Subjects.

Background . Cervical lymphadenopathy in children is common and its etiologies diverse. No systematic review of the differential diagnosis of pediatric cervical lymphadenopathy has been conducted. Objective . To determine the prevalence rate of specific etiologies of pediatric cervical lymphadenopathy. Data Sources . EMBASE, PubMed, and SCOPUS were searched electronically. Bibliographies of select studies were reviewed as well. Study Selection . (1) Any clinical trial, observational study, or cross-sectional case series with 10 or more subjects that included delineation of etiologies and/or associated conditions with lymphadenopathy; (2) subjects aged 0 to 21 years with enlarged lymphoid tissue on body; (3) lymphadenopathy was confirmed by clinical evaluation; and (4) no specific diagnoses were excluded. Data Extraction . Year and location of publication, definition of lymphadenopathy, percentage of lymphadenopathy that was cervical, total number of subjects, gender distribution of subjects, age range of patients, and specific etiologies. Results . Of the 1790 studies, 7 studies that were combined resulted in 2687 subjects that were selected. Nonspecific benign etiology was the most common diagnosis occurring at a rate of 67.8%. Epstein-Barr virus was the next most prevalent (8.86%), followed by malignancy (4.69%) and granulomatous disease (4.06%). The most common malignancy etiology was non-Hodgkin's lymphoma (46.0%), and the most common granulomatous disease was tuberculosis (73.4%). Conclusions . This systematic review and meta-analysis provides a rate-based differential diagnosis of pediatric cervical lymphadenopathy. Although the most common causes of pediatric cervical lymphadenopathy are nonspecific, the etiologies are diverse. Rates and credible intervals are provided to enable a probability-based diagnostic approach to palpable cervical lymphadenopathy in this age group.