Algorithm of Slap et al for When to Biopsy an Enlarged Peripheral Lymph Node in a Young Patient

Patient population:

(1) The patients were 9-25 years of age.

(2) The patients were seen at the Hospital of the University of Pennsylvania from 1953 to 1983, or the Children's Hospital of Philadelphia from 1969 to 1983.

Endpoints:

(1) Those patients who did not require lymph node biopsy to determine treatment:  normal, hyperplastic or benign inflammatory conditions. The last group included bacterial lymphadenitis and toxoplasmosis, since these could be diagnosed by lymph node aspiration or serologies respectively.

(2) Those patients with significant disease who needed lymph node biopsy to determine treatment: granulomatous disease, malignant lymphoma, metastatic tumor

Parameters used in discriminant stepwise analysis:

(1) chest roengtenogram

(2) lymph node size in cm

(3) ear, nose and throat symptoms (earache, coryza, or sore throat)

discriminant score =

= SUM(simplified coefficient values for the findings present)

Interpretation:

• minimum score: -5

• maximum score: +6

• If the score is <= 0, then it is unlikely that the patient will have a diagnosis that will require lymph node biopsy to determine treatment.

• If the score is > 0, then it is likely that the patient has a diagnosis that will require lymph node biopsy to determine treatment.

Performance:

• sensitivity: 95%

• specificity: 96%+

• positive predictive value: 95%+

• negative predictive value: 96%