Background/Purpose: Patients presenting solely with radiologic evidence of lymphadenopathy (LAD) to tertiary cancer centers are often diagnosed with malignancy or autoimmune diseases such as sarcoidosis.  However, the baseline characteristics predictive of a cancer or sarcoidosis diagnosis, clinical outcomes and follow-up time are unknown.

Methods: Retrospective chart review of adult patients (age > 18) presenting with LAD and without an apparent mass at other sites, such as the breast or prostate; seen at Mary Ann Weiser Suspicion of Cancer Clinic and rheumatology clinics at The University of Texas MD Anderson Cancer Center, new consultation from January 1, 2003, to June 30, 2007, and followed to December 31, 2011. Data collected and analyzed included age, sex, follow-up time, comorbidities, B symptoms, laboratory test results, imaging studies, histopathology analyses, and final diagnosis. Multiple logistic regression was used to asses baseline characteristics predictive of a cancer diagnosis.

Results: Of the 66 patients studied, 36 (55%) were diagnosed with cancer; the most common type was lymphoma. Sarcoidosis (17%) and reactive hyperplasia (23%) were the most commonly seen benign causes of LAD. Malignancy was diagnosed in 94%, 79%, and 70% of patients with supraclavicular, retroperitoneal, and abdominal LAD, respectively, suggesting an association between these locations and a cancer diagnosis. A benign diagnosis was more common with localized LAD than with generalized LAD (63% vs 37%). The final multiple logistic regression models showed age (used as a continuous variable) (p=0.0342) and hypertension (p=0.0399) to be associated with a cancer diagnosis.  Another model using age as a dichotomized variable (<50, ≥50) (p=0.0447) and hypertension (p=0.0245) showed both to be associated with a cancer diagnosis, suggesting hypertension and age as independent factors in predicting a cancer diagnosis. Other comorbidities like history of smoking, history of alcohol, history of prior cancer and rheumatologic disease did not have a significant association with a cancer diagnosis. Mean serum levels of angiotensin-converting enzyme (ACE) checked in 24 of the 66 patients, were higher in patients without cancer than in patients with cancer. No significant statistical correlation was observed between B symptoms and a cancer diagnosis.  On histopathology varying proportions of cell types were found in the lymph node specimens and a conclusive relationship with a particular diagnosis was not evident overall. The average follow-up time was 7 months, although in 1 of the patients a conclusive diagnosis was arrived at after 1 year. None of the patient’s with sarcoidosis progressed to a cancer diagnosis. 

Conclusion: Older patients with hypertension presenting to a cancer center with abdominal, retroperitoneal, or in particular supraclavicular LAD are at risk for the diagnosis of hematologic malignancy. We recommend that they should be followed for at least 1 year for a definitive diagnosis. A larger prospective study should be conducted to analyze other factors such as localized vs. generalized LAD or ACE levels (or other laboratory values) and their correlation with a cancer diagnosis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/diagnostic-predictors-and-clinical-outcomes-in-patients-presenting-solely-with-lymphadenopathy/