Lymphadenopathy and Lymphadenitis across the Diagnostic–Therapeutic Pathway: A Critical Review of Epidemiology, Mechanisms, Staging and Contemporary Surgical Practice
Jacques Forwah Ndeh *
Department of Hematology and Blood Transfusion Sciences, Faculty of Clinical Sciences, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
Edung Emem Samuel
Emergency Department, Basildon and Thurock University Hospital, London NHS Trust Foundation, London, United Kingdom.
Sewanu Bamidele Ajose
Department of Internal Medicine, Midyorkshire NHS Trust, England, UK.
Comfort Oluwapelumi Fasina
Department of Substance Abuse Services Cygnet Health Care, Barnsley, United Kingdom.
Scholarstica Ugonwa Ukakogu
Department of Medicine and Surgery, Molab Hospital, Ilorin, Nigeria.
Ikenna E. Megwara
Department of Emergency Medicine, University of Edinburgh, Edinburgh, United Kingdom.
Chukwudiebere Ekuma Oko
Department of Obstetrics and Gynaecology, Kubwa General Hospital, FCTA, Abuja Nigeria.
Olayiwola Rukayat Olawumi
Department General Medicine, University of Leicester, NHS Trust, Manchester, United Kingdom.
Jemima Mcdaniels
Department of Medicine, St Nicholas Hospital, Lagos Island, Lagos, Nigeria.
Maiyaki Yusuf
Department of Emergency Medicine, University of Manchester, Manchester, United Kingdom.
Nkechinyere Norah Iwara
Department of Community/Public Health, University of Calabar Teaching Hospital, Calabar, Crosss Rivers State, Nigeria.
Uwagwu Vivian Ewele
Department of Surgery, Federal Medical Centre, Ebutemetta, Lagos, Nigeria.
Imeobong Imeh Umoh
Department of Public Health, Glasgow Caledonian University, Glasgow, United Kingdom.
Chikwendu Izuchukwu
Department of General Medicine, University of Lagos/Avon Medical Practice, Lagos State, Nigeria.
Aniefiok Peter Awah
Department of Orthogeriatric Medicine, Barking, Havering, and Redbridge University Hospital, NHS Trust, Romford, UK.
Kwaku Oteng-Manu Addo
Department of Internal Medicine, Global Evangelical Mission Hospital, Apromase- Ashanti, Ghana.
Olamiji Felicia Ajayi
Department of General practice, Mercyland Hospital and Dental, Ife- Ibadan Expressway, Ibadan Oyo State, Nigeria.
Isu-Egwu Stella Nnenna
Department Internal Medicine, Federal Capital Territory Administration, Abuja, Nigeria.
Esther Oluwaseyi Alaiye
General Outpatient Department, Lagos State Primary Health Care Board, Lagos, Nigeria.
Oghenerukevwe Anthony Ovadje
Department of Emergency Medicine, Genezland Hospital, Lagos State, Nigeria.
Afusat Sobowale-Adams
Department of College of Medicine, University of Lagos, Lagos, Nigeria and Department of Emergency Medicine, Leicester University, United Kingdom.
Mauton Tolulope Hunjah
Department of Trauma and Orthopedics, Kettering General Hospital, Kettering, England, United Kingdom.
Abasiubong, Jesse Emmanuel
University of Uyo Teaching Hospital, Uyo Akwa Ibiom State, Nigeria.
Benjamin Essien
Department of Hematology and Blood Transfusion Sciences, Faculty of Clinical Sciences, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
Bassey Okon Bassey
Department of Hematology and Blood Transfusion Sciences, Faculty of Clinical Sciences, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
Ewa Anthony Obi
Department of Family Medicine, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
Idiege Idiege Omang
Department of Surgery, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
Akaba Kingsley Onoridea
Department of Hematology and Blood Transfusion Sciences, Faculty of Clinical Sciences, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
Nnaji Chimuanya Joseph
Department of Surgery, Nnandi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria.
Immaculate Ihuoma Ekeagba
Worcaccce Union Group Integrated Healthcare Sciences, Technological Development and Training and Innovative Research Foundation (WUGIHSTTAIRF), P.O Box 45 Bamenda, North West Region, Cameroon.
Abeshi Sylvester Etenikang
Department of Obstetrics and Gynecology, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Lymphadenopathy and lymphadenitis are common clinical findings but represent different biological processes and markedly different risks across age groups and healthcare settings. Enlarged lymph nodes may reflect a self-limiting immune response, focal infection, systemic inflammatory disease or neoplastic involvement; lymphadenitis denotes inflammation of nodal tissue and may be suppurative, granulomatous or non-infectious. Confusion between the finding and its cause can produce both diagnostic delay and unnecessary investigation. This critical narrative review evaluates published evidence on prevalence, aetiology, pathophysiology, diagnostic assessment, disease-specific staging, medical management and evolving surgical approaches. Peer-reviewed research, clinical guidance and pivotal randomised trials were considered through 16 August 2026, with methodological scrutiny directed at referral bias, diagnostic reference standards, treatment-selection effects and transferability across populations. The synthesis finds that the apparent prevalence of malignancy changes substantially with clinical setting, while node size or imaging appearance alone cannot safely determine aetiology. For suspected infection, microbiological confirmation and targeted antimicrobial treatment are preferable to indiscriminate empirical therapy; particular considerations apply to tuberculosis, non-tuberculous mycobacteria and paediatric suppurative disease. Fine-needle aspiration offers a relatively low-morbidity initial sampling route in appropriately selected adults, whereas core or excisional biopsy remains necessary when tissue architecture or molecular classification is decisive. Staging is meaningful only after identification of the underlying condition: lymphoma, head and neck carcinoma, breast cancer and melanoma employ distinct systems that cannot be applied to undifferentiated lymphadenopathy. Contemporary oncological trials support reduced nodal surgery for carefully defined patient groups, although surveillance infrastructure and accompanying systemic or radiotherapy treatments limit generalisation. Important evidence gaps remain in representative prevalence estimation, equitable access to timely diagnosis, prospective comparison of biopsy pathways and functional outcomes after surgery. Clinically useful decisions depend on integrated risk assessment, diagnostic stewardship and disease-specific multidisciplinary care rather than a single universal lymph-node algorithm.
Keywords: Cervical lymphadenopathy, lymphadenitis, differential diagnosis, tissue biopsy, tuberculous lymphadenitis, sentinel lymph node, nodal staging, surgical de-escalation