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Persistent Lymphadenopathy Biopsy — RACP Paediatrics MCQ

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ModerateInfectious DiseasePersistent Lymphadenopathy BiopsyRACP Paediatrics

A 6-year-old presents with a 4-week history of painless cervical lymphadenopathy. The node is 3 cm, non-tender, and firm. FBC is normal. A 4-week trial of antibiotics has not resolved the node. What investigation is most appropriate?

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Correct answer: A — Excisional biopsy (not FNA)

Persistent cervical lymphadenopathy (>4 weeks, >2 cm, firm, non-responsive to antibiotics) requires excisional biopsy to exclude malignancy (lymphoma) and other diagnoses (TB, atypical mycobacteria, cat scratch). FNA is inadequate for lymphoma diagnosis as architecture is needed.

Reference: RCH Melbourne – 2024 – Clinical Practice Guidelines: Lymphadenopathy