Approach to Evaluating Enlarged Lymph Nodes

Initial Assessment

The American Society of Hematology recommends asking about previous lymphoid neoplasms, particularly Hodgkin lymphoma, nodal anaplastic large cell lymphoma, and mycosis fungoides, as part of the initial assessment of enlarged lymph nodes 1
Inquiring about B symptoms, such as fever, night sweats, and weight loss, is crucial in the initial assessment of enlarged lymph nodes, as recommended by the American Society of Clinical Oncology 1, 2
Documenting the duration of lymphadenopathy, including any waxing and waning pattern, may suggest specific diagnoses, according to the American Society of Hematology 1
Assessing for a history of immunosuppression, such as HIV, organ transplantation, or immunosuppressive therapy, is an essential part of the initial assessment, as recommended by the American Society of Hematology 1
The American College of Radiology recommends documenting the size, number, and location of enlarged lymph nodes during the physical examination 1, 2
Examining for hepatosplenomegaly is a crucial part of the physical examination, as recommended by the American Society of Clinical Oncology 1, 2
Looking for associated skin findings or other organ system involvement is an essential part of the physical examination, according to the American Society of Hematology 1, 2

The American Society of Hematology recommends a complete blood count with differential as part of the laboratory evaluation of enlarged lymph nodes 1, 3
A blood chemistry panel, including lactate dehydrogenase (LDH), is recommended by the American Society of Clinical Oncology as part of the laboratory evaluation 1, 3
Considering serology for relevant infectious causes based on clinical presentation is an essential part of the laboratory evaluation, as recommended by the American Society of Hematology 1
The European Society for Medical Oncology recommends measuring β2-microglobulin, which may be helpful in certain cases of enlarged lymph nodes 3

The American College of Radiology recommends ultrasound as an excellent first-line imaging modality for accessible lymph nodes, which can assess size, shape, border characteristics, and internal architecture 4
The American Society of Clinical Oncology recommends CT scan for comprehensive evaluation of nodal and extranodal disease in cases of suspected malignancy or systemic disease 5, 6
The National Comprehensive Cancer Network recommends PET-CT for staging of FDG-avid lymphomas, which is superior to CT alone for detecting nodal and extranodal involvement 5, 6, 7

The American Society of Clinical Oncology recommends fine needle aspiration (FNA) as a first-line diagnostic procedure for accessible lymph nodes, which can be improved with ultrasound guidance 8
The College of American Pathologists recommends excisional biopsy as the gold standard for definitive diagnosis of lymphadenopathy, which is preferred over core biopsy for suspected lymphoma to preserve nodal architecture 9

The American College of Radiology recommends using size criteria to evaluate peripheral lymph nodes, with nodes >1.5 cm in long axis or >1.0 cm in short axis warranting further evaluation 2, 4
The American Society of Clinical Oncology recommends considering associated B symptoms, such as fever, night sweats, and weight loss, when suspecting malignancy 1, 2
The National Comprehensive Cancer Network recommends follow-up imaging based on treatment protocols and response assessment criteria for confirmed malignancy 2, 5