Endoscopic ultrasound:It’s accuracy in evaluating mediastinal lymphadenopathy? A meta-analysis and systematic review

AIM:To evaluate the accuracy of endoscopic ultrasound (EUS), EUS-fine needle aspiration (FNA) in evaluating mediastinal lymphadenopathy. METHODS:Only EUS and EUS-FNA studies confirmed by surgery or with appropriate follow-up were selected. Articles were searched in Medline, Pubmed, and Cochrane control trial registry. Only studies from which a 2 × 2 table could be constructed for true positive, false negative, false positive and true negative values were included. Two reviewers independently searched and extracted data. The differences were resolved by mutual agreement. Meta-analysis for the accuracy of EUS was analyzed by calculating pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratios. Pooling was conducted by both Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model). The heterogeneity of studies was tested using Cochran’s Q test based upon inverse variance weights. RESULTS:Data was extracted from 76 studies (n = 9310) which met the inclusion criteria. Of these, 44 studies used EUS alone and 32 studies used EUS-FNA. FNA improved the sensitivity of EUS from 84.7% (95% CI:82.9-86.4) to 88.0% (95% CI:85.8-90.0). With FNA, the specificity of EUS improved from 84.6% (95% CI:83.2-85.9) to 96.4% (95% CI:95.3-97.4). The P forchi-squared heterogeneity for all the pooled accuracy estimates was > 0.10. CONCLUSION:EUS is highly sensitive and specific for the evaluation of mediastinal lymphadenopathy and FNA substantially improves this. EUS with FNA should be the diagnostic test of choice for evaluating mediastinal lymphadenopathy.

Diagnostic approach using endosonography guided fine needle aspiration for lymphadenopathy in primary sclerosing cholangitis

We report a case of primary sclerosing cholangitis (PSC) with benign lyphadenopathy which was diagnosed with endosonography guided fine needle aspiration (EUS-FNA). A 65-year-old woman was admitted to Jikei University Hospital with severe jaundice. Although endoscopic retrograde cholangiography and liver biopsy revealed the findings consistent with PSC, abdominal computed tomography revealed numerous large perihepatic lymph nodes with a maximum diameter of more than 3 cm. Therefore, EUS-FNA was done in order to exclude malignant lymphadenopathy, and adequate specimens obtained by EUS-FNA showed reactive hyperplasia of lymphnode. The patients were scheduled to undergo liver transplantation.

First endoscopic procedure for diagnosis and staging of mediastinal lymphadenopathy

AIM:To compare a first diagnostic procedure of transbronchial needle aspiration(TBNA)with selection of endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA)or TBNA for mediastinal lymphadenopathy.METHODS:Sixty-eight consecutive patients with mediastinal lymphadenopathy on computed tomography(CT),who required cytopathological diagnosis,were recruited.The first 34 underwent a sequential approach in which TBNA was performed first,followed by EUS-FNA if TBNA was unrevealing.The next 34 underwent a selective approach where either TBNA or EUS-FNA was selected as the first procedure based on the CT findings.RESULTS:The diagnostic yield of TBNA as the first diagnostic procedure in the sequential approach was 62%.In the selective approach,the diagnostic yield of the first procedure was 71%.There was no significant difference in the overall diagnostic yield,but there were significantly fewer combined procedures with the selective approach.CONCLUSION:Selecting either EUS-FNA or TBNA as the first diagnostic procedure achieved a comparable diagnostic yield with significantly fewer procedures than performing TBNA first in all patients.

Abdominal lymphadenopathy:An atypical presentation of enteric fever

This is a case report of a patient who presented to the Aga Khan University Hospital with generalized abdominal lymphadenopathy and high-grade fever.Due to ambiguous clinical findings,which were suggestive of either abdominal tuberculosis,or a lymphoma,the patient was started on empirical anti-tuberculous treatment due to the endemicity of tuberculosis in this region.The blood culture reports,however,were reported to grow colonies of Salmonella paratyphi A;thus the diagnosis of the patient was changed to enteric fever,and the patient improved on the subsequently started therapy of ceftriaxone 2000 mg bid.To the best of our knowledge,this is the first reported case of a patient suffering from enteric fever whose primary clinical findings were abdominal lymphadenopathy and fever.

Efficiency of EBUS-TBNA for diagnosing benign and malignant lymphadenopathy

Objective:To determine whether endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can rapidly distinguish among lung cancer,tuberculosis and sarcodosis,and to explore its sensitivity and specificity.Methods:Clinical data of patients with enlarged mediastinal or hilar lymphadenopathy who underwent EBUS-TBNA at our hospital between September 1,2012 and June 30,2015 for were retrospectively analyzed.The sensitivity,specificity,positive predictive value,and negative predicted value [including 95% confidence interval (CI)] were calculated..Results:A total of 299 lymph nodes from 201 patients underwent EBUS-TBNA were selected and no serious complications occurred.EBUS-TBNA showed a sensitivity of 87.9% (124/141) (95% CI:81%-92%),a specificity of 100.0% (124/124) (95% CI:97%-100%),and a negative predicted value of 41.3% (95% CI:23%-61%) in the detection of lung cancer.The sensitivity and specificity of diagnosis of mediastinal tuberculosis lymphadenitis were 72.4% (21/29) (95% CI:53%-87%) and 100.0% (95% CI:82%-100%);while sensitivity and specificity of diagnosis of sarcoidosis were 71.4% (5/7) (95% CI:29%-96%) and 100.0% (95% CI:91%-100%).Conclusions:The sensitivity and specificity of EBUS-TBNA do not significantly differ for a diagnosis of lung cancer versus tuberculosis or sarcodosis.

Malignant transformation of biliary adenofibroma combined with benign lymphadenopathy mimicking advanced liver carcinoma:A case report

BACKGROUND Biliary adenofibromas(BAFs)are rare primary hepatic neoplasms,some of which can potentially undergo malignant transformation.Here,we describe a rare case of malignant transformation of BAF.CASE SUMMARY A 51-year-old female was referred to our hospital with epigastric pain.Computed tomography showed a solitary liver mass combined with the enlargement of multiple mediastinal and cervical lymph nodes,clinically mimicking a liver carcinoma with extensive lymph node metastasis.However,core needle biopsy suggested BAF with malignant transformation.Finally,the patient underwent curative resection of the neoplasm and was recurrence-free for 12 mo.CONCLUSION Our case serves as an example of a rare manifestation of BAF.Our report and the previously published experience,reinforce that curative resection should be considered the primary treatment for BAFs with malignant transformation,leading to a favorable prognosis.

Endobronchial ultrasound-guided transbronchial needle aspiration in intrathoracic lymphadenopathy with extrathoracic malignancy

BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)for the diagnosis of mediastinal and hilar lymph is poorly studied in patients with extrathoracic malignancies.AIM To evaluate the value of EBUS-TBNA for the diagnosis of enlarged intrathoracic lymph nodes in patients with extrathoracic malignancies.METHODS This was a retrospective study of patients with extrathoracic malignancies who were referred to Peking University Cancer Hospital from January 2013 to December 2018 for EBUS-TBNA due to intrathoracic lymphadenopathy.The specimens were defined as positive for malignancy,negative for non-malignancy(tuberculosis,sarcoidosis,etc.),and without a definitive diagnosis.Sensitivity,negative predictive value(NPV)for malignancy,and overall accuracy were calculated.Complications were recorded.RESULTS A total of 80 patients underwent EBUS-TBNA and had a final diagnosis,among which 50(62.5%)were diagnosed with extrathoracic malignancy with intrathoracic lymph nodes metastasis,14(17.5%)were diagnosed with primary lung cancer with nodal involvement,and 16(20.0%)exhibited benign behavior including tuberculosis,sarcoidosis and reactive lymphadenitis or who had benign follow-up.The diagnostic sensitivity,NPV,and accuracy of EBUS-TBNA for intrathoracic lymphadenopathy in patients with extrathoracic malignancy were 93.8%(n=60/64),80.0%(n=16/20),and 95.0%(n=76/80),respectively.In the multivariate analysis,longer short axis of the lymph node(OR:1.200,95%CI:1.024-1.407;P=0.024)and synchronous lung lesion(OR:19.449,95%CI:1.875-201.753;P=0.013)were independently associated with malignant intrathoracic lymphadenopathy.No characteristics of the lymph nodes and EBUS-TBNA were associated with the location of malignant intrathoracic lymphadenopathy,and no major complication was observed.CONCLUSION EBUS-TBNA is a simple and accurate procedure for the diagnosis of intrathoracic lymphadenopathy with extrathoracic malignancy.

Mediastinal lymphadenopathy in COVID-19: A review of literature

A novel coronavirus disease 2019(COVID-19)is a progressive viral disease that affected people around the world with widespread morbidity and mortality.Patients with COVID-19 infection typically had pulmonary manifestation but can also present with gastrointestinal,cardiac,or neurological system dysfunction.Chest imaging in patients with COVID-19 commonly show bilateral lung involvement with bilateral ground-glass opacity and consolidation.Mediastinal lymphadenopathy can be found due to infectious or non-infectious etiologies.It is commonly found to be associated with malignant diseases,sarcoidosis,and heart failure.Mediastinal lymph node enlargement is not a typical computer tomography of the chest finding of patients with COVID-19 infection.We summarized the literature which suggested or investigated the mediastinal lymph node enlargement in patients with COVID-19 infection.Further studies are needed to better characterize the importance of mediastinal lymphadenopathy in patients with COVID-19 infection.

Metastatic Cervical and Supraclavicular Lymphadenopathy from Prostate Mimicking Lymphoma: A Case Series

Prostate cancer is the second most common cancer in men worldwide and the commonest cause of mortality in men. It is the commonest diagnosed cancer in African men. The earliest and common sites of metastasis are the axial skeleton and regional lymph nodes. Initial presentation of the metastatic disease with cervical or supraclavicular lymphadenopathy is rarely reported. We report 3 cases of metastatic cancer of the prostate presenting initially to physicians with huge cervical and supraclavicular lymph nodes enlargement which on biopsy revealed metastatic adenocarcinoma. On further evaluation, there were non-bothersome storage symptoms, elevated prostate specific antigen and abnormal digital rectal examination. Transrectal ultrasound (TRUS)-guided biopsy of hypoechoic nodules revealed high-grade adenocarcinoma of the prostate on histopathological examination. The cervical and supraclavicular lymphadenopathy resolved after commencement of androgen deprivation therapy. We advocate for prostate cancer screening in African men above 50 years of age presenting with cervical or supraclavicular lymphadenopthy to primary care physicians even in the absence of lower urinary tract symptoms.

Therapeutic Effect of Oral Administration and External Therapy of Traditional Chinese Medicine on Cervical Tuberculous Lymphadenopathy

Objective:To analyze the clinical effect and value of oral administration and external therapy of traditional Chinese medicine for treatment of cervical tuberculous lymphadenopathy.Methods:A total of 56 patients with cervical tuberculous lymphadenopathy admitted to our hospital from January 1 to January 2018 were recruited.By using double-blind method,the patients were divided into control group(n=28)and experimental group(n=28).Control group comprised of patients with conventional anti-tuberculosis treatment,while the experimental group comprised of patients treated with oral administration and external therapy of traditional Chinese medicine.Total effective rate,incidence of complication and level of T lymphocyte subsets were compared between the two groups of cervical tuberculous lymphadenopathy patients.Results:Post-treatment data of total effective rate,complication rate,CD3+,CD4+,CD8+,CD4+/CD8+of the experimental group were compared with the control group.P<0.05;statistical analysis showed statistical significance.Post-treatment data of CD3+,CD4+,CD8+,CD4+/CD8+of both control and experimental groups were compared with pre-treatment data.P<0.05;statistical analysis showed statistical significance.Conclusion:Oral administration and external therapy of traditional Chinese medicine possesses significant effect in treatment of cervical tuberculous lymphadenopathy.

IMMUNOBLASTICLYMPHADENOPATHY－LIKE T－CELLL YMPHOMA：A CLINICOPATHOLOGIC AND IMMUNOPHENOTYPIC ANALYSIS OF 24 CASES

The histopathology, immunophenotype and clinical presentations of 24 cases of immunoblastic lymphadenopathy(IBL)-like T-cell lymphoma were studied. The results showed that fever and generalized lymphadenopathy were the first appeared and more commonly occurred clinical manifestations. 12 of 19 cases(63. 2%) which had been followed up died of relapse and progression of the disease.Pathologically, focus and/ or sheet- like proliferation of tumorous lymphoid cells, including pale cells and convoluted cells with obliteration of involved lymph nodes was the histologic feature of the disease. Within these 24 cases of IBL-like T-cell lymphomas diagnosed by morphologic criteria, tumor cells of 20 cases gave positive reaction to T-cellmarkers and the remaining 4 cases were reactive to B cell markers as well. Immunoblasts and plasma cells showed polyclonal proliferation. Immunotypic analysis showed that rearrangement of T-cell receptor beta chain was detected in 1 case of the disease. Pathologic diagnosis of the disease and relationships between biologic behaviors and the prognosis were also discussed.

Mediastinoscopy in Assessing Mediastinal Lymphadenopathy and Lung Disease

Background: Mediastinoscopy is the gold standard procedure for the pathological staging and diagnosis of mediastinal diseases. The aim of the study is to describe the significance of anterior cervical Mediastinoscopy in evaluating patients with mediastinal lymphadenopathy and lung parenchymal disease. Material and Methods: From January 2014 until June 2017 we conducted a retrospective study of 52 consecutive patients with mediastinal lymphadenopathy and lung parenchymal disease who underwent anterior cervical Mediastinoscopy. The main indications for cervical Mediastinoscopy were isolated mediastinal lymphadenopathy, undetermined lung mass with mediastinal lymphadenopathy, and the clinical staging of patients with lung cancer. Results: The study subjects consisted of 37 men and 15 women, aged 13 to 87 (mean age 50.8). Eight patients had mediastinoscopy for staging lung cancer, 27 patients had mediastinoscopy to diagnose isolated mediastinal lymphadenopathy, and 17 patients had mediastinoscopy for an undetermined lung parenchymal mass. Among the patients with isolated mediastinal lymphadenopathy, sarcoidosis was diagnosed in 6, tuberculosis in 9, reactive lymph nodes in 4, metastasis in 5 and lymphoma in 3. Lymph node metastasis (N2, N3) was found in 5 patients with lung cancer. There was no surgical-related mortality or morbidity. Conclusions: Mediastinoscopy is a safe and reliable procedure in diagnosing mediastinal diseases and is still the first choice among the investigative modalities in the clinical staging of bronchogenic carcinoma.

Generalized lymphadenopathy as an atypical initial clinical manifestation in rheumatoid arthritis and a possible hypothetical mechanism

Objective:To describe a 60-year-old male with diffuse generalized lymphadenopathy preceding a diagnosis of rheumatoid arthritis.Case presentation:The patient was admitted on suspicion of lymphoma.Chest positron emission/computed tomography showed enlarged lymph nodes bilaterally,mediastinum in the perihilar,retroperitoneum,and inguinal regions,with normal hematopoiesis of bone marrow.Lymph node biopsy revealed reactive follicular lymphadenopathy.Polyarthritis was present,and a rheumatoid factor test was positive eight months after the initial medical evaluation.A diagnosis of rheumatoid arthritis associated with generalized lymph node involvement was made.The patient was treated with leflunomide and corticosteroids and showed complete recovery without recurrence at 18 months of follow-up.Conclusions:Once histological findings of reactive lymph node hyperplasia are established as primarily related to rheumatic disease activity,clinicians should consider a possible diagnosis of rheumatoid arthritis.

Porta Hepatis Tuberculous Lymphadenopathy: Clinical and Imaging Features of 10 Cases

Porta hepatis tuberculous lymphadenopathy(TL)is rare,and the clinical and imaging manifestations often mimic tumors.To offer a bet-ter understanding of porta hepatis TL and thus improve its diagnosis and treatment,here,we retrospectively reviewed and analyzed 10 porta hepatis TL cases between May 2017 and November 2022.In this study,porta hepatis TL occurred predominantly in women(70%),with a mean age of 43.1 years(range,16-70 years).Among the patients,60%were initially suspected of malignancy(metastatic lymphadenopathy and lymphoma).The clinical manifestations were nonspecific,such as fever and weight loss,without overt abdominal malaise.Many patients showed high concentrations of serum C-reactive protein,erythrocyte sedimentation rate,alkaline phosphatase,γ-glutamyl transpeptidase and carbohydrate antigen 125.Peripheral rim-like enhancement was a characteristic finding on contrast-enhanced CT for all the patients.Pathological examination confirmed the diagnosis in 90%of patients with caseous granulo-matous inflammation and positive results of Xpert MTB/RIF,quantitative real-time PCR and/or metagenomic next-generation sequenc-ing assays.All patients underwent antituberculosis therapy with a median treatment duration of 13.5 months(range,1-43 months).They all showed satisfactory therapeutic responses with improved symptoms and resolution on imaging after treatment.Pathological examination by biopsy remains the primary diagnostic method.A combination of the characteristic epidemiologic,clinical,imaging fea-tures and lesion biopsy for histopathology are essential for the diagnosis and treatment of TL.

Mpox re-emerges:Historical background,symptom overview,and contemporary treatment options

As the global community continues to recover from the COVID-19 pandemic,the World Health Organization has issued a warning of another viral infection,mpox(monkeypox),that can pose a significant threat to public health.Mpox was once endemic in Africa but has spread globally,prompting the World Health Organization to declare it a public health emergency.In response,healthcare personnel must initiate timely,decisive,and robust action before the infection escalates.Moreover,accurate diagnosis is crucial,given the similarity between mpox and other rash-causing infections.This article provides a comprehensive overview of the symptoms,differentiating it from similar diseases,risk assessment,and treatment strategies.In addition,it aims to educate healthcare personnel with the necessary knowledge to educate others and take preventative measures when handling cases,thereby avoiding the spread of infection.

A Case Report of Bartonella henselae Infection Causing Fever of Unknown Origin: Unveiling a Stealthy Pathogen

Bartonella species are bacterial pathogens responsible for Cat Scratch Disease (CSD) with various clinical manifestations, ranging from self-limiting febrile illnesses to severe systemic infections. Diagnosis is often challenging due to its insidious nature and variable presentation based on the body’s immune status. Such a scenario emerged when a 25-year-old male presented to our hospital with nonspecific symptoms of Fever of unknown origin that were not responding to antibiotics until a timely diagnosis of Bartonella infection. This case report highlights the importance of considering Bartonella as a potential etiology in patients with prolonged Fever of unknown origin, especially in endemic regions.

Endobronchial ultrasound-guided transbronchial needle aspiration of undiagnosed mediastinal lymphadenopathy

Background Endobronchial ultrasound-guided transbronchial needle aspiration （EBUS-TBNA） can sample the enlarged mediastinal lymph nodes which are unreachable by conventional bronchoscopy.It is a relatively simple and safe method to see beyond the bronchial tree.We describe and discuss its initial application and our experience.Methods From July 2009 to December 2009, 52 patients with undiagnosed enlarged mediastinal lymph nodes were accessed with EBUS-TBNA in the People＇s Liberation Army General Hospital.Conventional bronchoscopy was performed before EBUS-TBNA, and patients with endobronchial lesions were excluded from this study.Smears fixed in 95% alcohol and histological specimens fixed in formalin were sent to Department of Pathology.Results EBUS-TBNA was diagnostic in 33 （63%） patients, with diagnosis of lung cancer in 23 patients （14 patients of small cell lung cancer, eight patients with adenocarcinoma, and one patient of squamous carcinoma）.Four patients, who had negative EBUS-TBNA results, were later diagnosed with malignancy at thoracotomy.One patient with negative EBUS-TBNA results died of cancer cachexia.The sensitivity, specificity, and positive and negative predictive value of EBUS-TBNA for the diagnosis of neoplastic disease were 85%, 100%, 100%, and 50% respectively.Among the 16sarcoidosis patients, who were diagnosed by a combination of the clinical and radiological information as well as pathological results obtained by EBUS-TBNA, nine of them had granulomas and benign lymphoid cells detected by EBUS-TBNA.The sensitivity, specificity, and positive and negative predictive value of EBUS-TBNA for the diagnosis of sarcoidosis were 56%, 100%, 100%, and 13%, respectively.Five patients with no definite diagnosis from EBUS-TNBA examination are under close follow-up.Conclusions EBUS-TBNA can provide a safe and effective method to sample mediastinal leisions suspected of malignancy.It also adds pathological information needed to make the diagnosis of sarcoidosis.

The diagnostic and prognostic values of plasma Epstein-Barr virus DNA for residual cervical lymphadenopathy in nasopharyngeal carcinoma patients:a retrospective study

Background:Currently,the diagnosis and treatment of nasopharyngeal carcinoma(NPC)patients with residual cervical lymphadenopathy following radical radiotherapy with or without chemotherapy are challenging.We investigated the prognosis of NPC patients with residual cervical lymphadenopathy and assessed the diagnostic and prognostic values of Epstein-Barr virus(EBV)DNA in these patients.Methods:This study included 82 NPC patients who were diagnosed with suspected residual cervical lymphadenopathy following completion of antitumor therapy.Their plasma EBV DNA levels were measured using quantitative polymerase chain reaction(qPCR)before the initiation of treatment and before neck dissection.Fine needle aspiration cytology(FNAC)was performed in 21 patients.All patients had undergone neck dissection and postoperative pathological examination to identify the nature of residual cervical lymphadenopathy.The overall survival(OS),progression-free survival(PFS),distant metastasis-free survival(DMFS),and locoregional relapse-free survival(LRRFS)were calculated using the Kaplan-Meier method and compared using the log-rank test.The Cox proportional hazards model was used to calculate hazard ratios(HRs)with 95%confidence intervals(CIs).Multivariable analysis was used to estimate the effect of potential prognostic factors on survival.Results:Following a median follow-up of 52.6 months,compared with patients with negative postoperative pathological findings for residual cervical lymphadenopathy,the patients with positive findings had a significantly lower 3-year PFS rate(49.9%vs.83.3%,P=0.008).Among NPC patients with residual cervical lymphadenopathy,the patients with preoperative plasma EBV DNA>0 copy/mL had a lower 3-year PFS rate than did those with no detectable EBV DNA(43.7%vs.61.1%,P=0.031).In addition,combining FNAC with preoperative EBV DNA detection improved the diagnostic sensitivity.Multivariable analysis demonstrated that residual cervical lymphadenopathy with positive postoperative pathological result was an independent prognostic factor for PFS and that detectable preoperative plasma EBV DNA was an independent prognostic factor for OS.Conclusions: Using FNAC combined with preoperative EBV DNA detection improves the sensitivity in diagnosing NPC with residual cervical lymphadenopathy. Compared with patients with undetectable EBV DNA, patients with detectable preoperative plasma EBV DNA have worse prognosis and may require a more aggressive treatment strategy.

Gaucher Disease with Mesenteric Lymphadenopathy： A Case with 13-year Follow-up

Mesenteric lymphadenopathy is a rare manifestation of Gaucher disease （GD） with only 26 cases reported worldwide and its outcome remains largely unknown.In this manuscript,we described a 17-year-old girl with GD who has been treated with standard enzyme replacement therapy （ERT） for 16 years.The follow-up of her mesenteric lymphadenopathy began 13 years ago,which is one of the longest follow-up for this condition worldwide.

18F-FDG PET/CT makes a significant contribution to diagnosis of malignancy in patients with cervical lymphadenopathy： a study using optimal scale regression tests

Background The specificity and precision of lymphadenopathy assessment using US, CT and MRI are generally unsatisfactory, while fluorodeoxyglucose-positron emission tomography/computed tomography （18F-FDG PET/CT） can support this process by providing additional information about the lymph node features. However, which image features of 18F-FDG PET/CT play the key role in the diagnosis and cutoffs of malignant cervical lymphadenopathy still needs to be determined by further studies. Our study aimed to identify 18F-FDG PET/CT abnormalities that would assist in making a reliable diagnosis of malignant cervical lymphadenopathy in enlarged cervical lymph nodes of patients with unknown primary diseases. Methods One hundred and ninety-one consecutive patients of cervical lymphadenopathy with unknown primary causes were examined by 18F-FDG PET/CT from May 2007 to October 2011 and a definite diagnosis was established by pathologic biopsy. 18F-FDG PET/CT images were evaluated to identify the relevant abnormalities. All image features were analyzed by optimal scale regression tests to determine the important factors that were predictive for the diagnosis of malignant cervical lymphadenopathy and the cutoffs. Results The factors studied in 18F-FDG PET/CT images for predicting malignant cervical lymphadenopathy were sex, age, node location, size, shape, margins, maximum standard uptake value （SUV）, mean SUV, FDG uptake pattern and number of nodes. It was found that mean SUV, maximum SUV, FDG uptake pattern, location, size and margins were the important risk factors of cervical lymph nodes that could predict malignant cervical lymphadenopathy. Signs of mean SUV〉2.5 （or maximum SUV〉3.5）, nodular FDG uptake pattern, location of IIA, III, IV, VB, VI and VII regions, size〉1.5 cm and vague margins had their optimal diagnostic accuracy （Ac） and Youden index （YI）, further, combination of any three factors of these six important risk factors would led to the best diagnosticAc of 96% and YI of 0.93. Conclusions Signs of mean SUV, maximum SUV, FDG uptake pattern, location, size and margins of node in ~SF-FDG PET/CT imaging are important predictive factors of malignant cervical lymphadenopathy. A combination of multiple factors may yield a higher diagnostic efficacy.