When is lymph node biopsy indicated in children with enlarged peripheral nodes?

To better define the indications for diagnostic biopsy, 239 children who underwent peripheral lymph node biopsy were reviewed. The duration of the lymph-adenopathy by history, the consistency of the lymph nodes, and the presence of more than one site of palpable adenopathy were not specific in differentiating serious diseases involving lymph nodes from reactive hyperplasia. The differential diagnosis of specific causes for lymph node enlargement is approached based on the child's age, the location of the adenopathy, and the presence or absence of lymph node fixation and tenderness. Most children with supraclavicular adenopathy, children sick with fever of one week's duration or with weight loss for which a specific diagnosis is not readily made, and some children with fixation of the lymph node to the overlying skin should undergo early biopsy. Excluding the above findings, when a specific diagnosis is not apparent, serial measurements with a ruler over several weeks appears to be the most reasonable method, at the present time, of discriminating hyperplastic lymph nodes from nodes that are involved by a progressive disease process.