Superficial lymphadenopathy

• No routine tests: simple monitoring if few symptoms and moderate size

Laboratory tests

• FBC
• CRP
• EBV serology
• CMV serology
• Toxoplasmosis serology
• Bartonella henselae serology (if contact with a cat)if neededIf contact with a cat.
• HIV serologyif neededPersistent cervical lymphadenopathy with no cause: HIV seroconversion is among the causes to look for, with EBV, CMV and toxoplasmosis, all the more so after a risk exposure.
• syphilis serologyif neededSexual risk-taking, notably oral.
• Serum protein electrophoresis (depending on the context)if neededLymphadenopathy with no obvious local cause: a French general practice textbook includes them in the minimum initial tests, to be requested depending on the clinical context ^[7].
• AST (depending on the context)if neededLymphadenopathy with no obvious local cause: a French general practice textbook includes them in the minimum initial tests, to be requested depending on the clinical context ^[7].
• ALT (depending on the context)if neededLymphadenopathy with no obvious local cause: a French general practice textbook includes them in the minimum initial tests, to be requested depending on the clinical context ^[7].
• LDH (depending on the context)if neededLymphadenopathy with no obvious local cause: a French general practice textbook includes them in the minimum initial tests, to be requested depending on the clinical context ^[7].
• Serum creatinine with GFR (if lymphoma suspected)if needednon-French guidelineSuspected lymphoma: the Scottish guidelines and the Australian pathway include renal function in the GP's tests ^[4,5], to detect organ involvement ^[4]. In France, the Pilly textbook cites creatinine among the guiding tests to request according to the clinical picture ^[8].
• Serum calcium (if lymphoma suspected)if needednon-French guidelineSuspected lymphoma: the Scottish guidelines and the Australian pathway include serum calcium in the GP's tests ^[4,5], to detect organ involvement ^[4]. The French references of this page do not cite it ^[7,8].

Laboratory tests

• FBC
• CRP

Laboratory tests

• FBCif neededNo obvious cause on examination of the draining area, deterioration in general condition, or large lymph node (> 2 cm).
• CRPif neededNo obvious cause on examination of the draining area, deterioration in general condition, or large lymph node (> 2 cm).
• Bartonella henselae serology (if contact with a cat)if neededIf contact with a cat.

Laboratory tests

• FBCif neededNo obvious cause on examination of the draining area, deterioration in general condition, or large lymph node (> 2 cm).
• CRPif neededNo obvious cause on examination of the draining area, deterioration in general condition, or large lymph node (> 2 cm).
• Bartonella henselae serology (if contact with a cat)if neededIf contact with a cat.
• Syphilis serology (if at-risk sexual exposure or rash)if needednon-French guidelineSexual risk exposure or suggestive rash: American Family Physician cites secondary syphilis among the causes of epitrochlear lymphadenopathy ^[1], and the Pilly also lists it among the causes to look for in this area ^[8].

Laboratory tests

• FBCif neededNo obvious cause on examination of the draining area, deterioration in general condition, or large lymph node (> 2 cm).
• CRPif neededNo obvious cause on examination of the draining area, deterioration in general condition, or large lymph node (> 2 cm).
• Bartonella henselae serology (if contact with a cat)if neededIf contact with a cat.
• syphilis serologyif neededThink of a sexually transmitted infection: syphilis above all, more rarely chancroid or lymphogranuloma venereum.
• HIV serology (if at-risk sexual exposure)if needednon-French guidelineSexual risk behaviour: American Family Physician then pairs an HIV test with the syphilis test ^[1]. In France, HIV is among the serologies to be adapted to the causes considered ^[8].
• Chlamydia trachomatis and gonococcus NAAT (PCR) (if genital ulceration, urethritis or proctitis)if needednon-French guidelineSuspected lymphogranuloma venereum, cited by the Pilly without an associated test ^[8]: American Family Physician has nucleic acid amplification done for Chlamydia in case of sexual risk behaviour ^[1]. Several sites can be sampled according to practices (procedures 5302 and 5303).

• No routine laboratory tests.

• No routine laboratory tests.

Laboratory tests

• FBC
• CRP
• EBV serology
• CMV serology
• Toxoplasmosis serology
• Tuberculin skin test
• HIV serologyif neededPolyadenopathy with no obvious cause: serology guided by the history, to be offered notably after sexual risk exposure.
• LDHif neededTumour context: deterioration in general condition, bone pain, bone marrow failure, superior vena cava syndrome, pruritus, sweats (leukaemia, lymphoma).
• Antinuclear antibodies (ANA)if neededInflammatory context: arthromyalgia, hepatosplenomegaly, skin, digestive or ENT signs (lupus, Still's disease, macrophage activation syndrome…).
• Rheumatoid factorif neededInflammatory context: arthromyalgia, hepatosplenomegaly, skin, digestive or ENT signs (lupus, Still's disease, macrophage activation syndrome…).
• Serum ferritinif neededInflammatory context: arthromyalgia, hepatosplenomegaly, skin, digestive or ENT signs (lupus, Still's disease, macrophage activation syndrome…).
• Serum protein electrophoresis (depending on the context)if neededLymphadenopathy with no obvious local cause: a French general practice textbook includes them in the minimum initial tests, to be requested depending on the clinical context ^[7].
• AST (depending on the context)if neededLymphadenopathy with no obvious local cause: a French general practice textbook includes them in the minimum initial tests, to be requested depending on the clinical context ^[7].
• ALT (depending on the context)if neededLymphadenopathy with no obvious local cause: a French general practice textbook includes them in the minimum initial tests, to be requested depending on the clinical context ^[7].
• Serum creatinine with GFR (if lymphoma suspected)if needednon-French guidelineSuspected lymphoma: the Scottish guidelines and the Australian pathway include renal function in the GP's tests ^[4,5], to detect organ involvement ^[4]. In France, the Pilly textbook cites creatinine among the guiding tests to request according to the clinical picture ^[8].
• Serum calcium (if lymphoma suspected)if needednon-French guidelineSuspected lymphoma: the Scottish guidelines and the Australian pathway include serum calcium in the GP's tests ^[4,5], to detect organ involvement ^[4]. The French references of this page do not cite it ^[7,8].
• Syphilis serology (if at-risk sexual exposure or rash)if needednon-French guidelineSexual risk exposure or rash: the American Family Physician algorithm includes a syphilis test ^[1]. In France, the minimum tests of a French general practice textbook and the Pilly also cite syphilis ^[7,8], which here remains guided by the history.
• Hepatitis B serology (if at-risk exposure or raised transaminases)if needednon-French guidelineExposure to hepatitis B virus or cytolysis: the American Family Physician algorithm includes HBsAg ^[1]. The French references of this page do not provide for this test ^[7,8]; hepatitis is in the list of causes in the “Cervical” tab.

Laboratory tests

• FBC with blood film
• CRP
• EBV serology
• CMV serology
• Toxoplasmosis serology
• Parvovirus B19 serology (IgG and IgM, recent infection)
• Bartonella henselae serology (if contact with a cat)if neededContact with a cat (scratch, lick); indicated depending on the context ^[12].
• Tuberculin skin test (if contact with a case, stay in an endemic area or persistent lymphadenopathy)if neededTuberculosis contact, stay in an endemic area, or persistent lymphadenopathy with no diagnosis: looking for tuberculosis or mycobacterial infection ^[12].
• IGRA (QuantiFERON) (same context as the tuberculin skin test)if neededSame context as the skin test; proposed with the skin test by the paediatricians' reference document ^[12].
• HIV serology (depending on the context, generalised lymphadenopathy)if neededDisseminated lymphadenopathy with a mononucleosis-like syndrome, depending on the clinical context ^[12].