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©2013 UpToDate ® Print Email Suggested approach to generalized adenopathy in children EBV: Epstein-Barr virus; CMV: cytomegalovirus; CBC: complete blood count; ESR: erythrocyte sedimentation rate; CXR: chest radiograph; PPD: purified protein derivative; ANA: antinuclear antibody. * Early biopsy is indicated in children with supraclavicular, mediastinal, or massively enlarged nodes or groups of nodes >3 cm. • Toxoplasmosis, histoplasmosis, coccidiomycosis, brucella, rapid plasma reagin (RPR), HIV. Δ Of the most abnormal node. Based on information from: Soldes OS, Younger JG, Hirschl RB. Predictors of malignancy in childhood peripheral lymphadenopathy. J Pediatr Surg 1999; 34:1447. Slap GB, Brooks JS, Schwartz JS. When to perform biopsies of enlarged peripheral lymph nodes in young patients. JAMA 1984; 252:1321.