Yishai Haimi-Cohen ^1,2,3* Eyal Elron ^3,4 Lital Oz-Alcalay ^5* Lama Hejly ^1* Roy Hod ^3,6* Liat Ashkenazi- Hoffnung ^1,2,3

• ¹ Department for Day Hospitalization, Schneider Children's Medical Center Of Israel, Petah Tikva, Israel
• ² Infectious Diseases Unit, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
• ³ Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Tel Aviv, Israel
• ⁴ Department of Neonatology and Neonatal Intensive Care, Schneider Children's Medical Center, Petach-Tikva, Israel
• ⁵ Schneider Children's Medical Center, Petach Tikva, Israel
• ⁶ Department of Otorhinolaryngology, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel

Aims: To describe the factors associated with malignancy in otherwise healthy children with focal persistent isolated craniocervical lymphadenopathy at low risk for malignancy, in order to aid in decisions of nodal surgical excision. Material and Methods: Demographic and clinical data were retrospectively obtained for children with subacute and chronic craniocervical lymphadenopathy, treated from January 2008 to December 2020 at a general pediatric ambulatory clinic of a tertiary center. Univariate and multivariate analyses of risk factors for malignancy were performed. Results: Of the 450 children included, median age 4.2 years (interquartile age: 2.4–8.7), 25 (5.6%) were eventually diagnosed with a malignancy. In univariate analysis, factors associated with malignancy included older age, increased nodal size, location (supraclavicular and lateral cervical), systemic signs such as decreased appetite and weight loss, and abnormal imaging studies. Referral by an ear, nose, throat specialist versus a family physician or a pediatrician was also associated with malignancy. Fever, night sweats, pruritus, hepatosplenomegaly and laboratory workup were not associated with malignancy. Twenty percent of the children older than 12.5 years and 12% of those with a lymph node diameter >31 mm were diagnosed with malignancy. Multivariate analysis showed associations with malignancy of older age and larger lymph nodes; the respective odds ratios were 1.649 (95%CI:1.197-2.349, p=0.004) for every 3 years and 2.080 (95%CI:1.292-3.330, p=0.002) for every one centimeter. Conclusions: Older age and increased nodal size can help identify children with focal craniocervical lymphadenopathy who are at increased risk for malignancy and for whom surgical intervention should be strongly considered.