• A Quick Diagnosis Unit evaluated 485 patients with unexplained lymphadenopathy, diagnosing malignancy in 21% of cases. • Age ≥50 years, male sex, lymph node size >25.5 mm, indurated consistency and supraclavicular location independently predicted malignancy. • The QDU model enabled rapid diagnostic assessment, with 11 days to first consultation and 26.5 days to histological diagnosis. • Ultrasound showed excellent diagnostic performance, with 99% sensitivity and negative predictive value. • Absence of high-risk clinical and ultrasound features identified patients at very low risk of malignancy, supporting selective investigation strategies. . Peripheral lymphadenopathy (LA) has diverse causes and may indicate malignancy, particularly in referred patients. . To characterize patients referred for unexplained-LA to a Quick Diagnosis Unit, and identify independent predictors of malignancy. . We conducted a retrospective study of 485 consecutive adults evaluated for unexplained-LA between 2017 and 2023. The primary outcome was malignancy. Secondary outcomes included diagnostic delay and time to oncology referral. Demographic, clinical, and laboratory variables were compared across etiological groups. A parsimonious multivariable logistic regression model included five clinically relevant predictors identified in univariable analyses and supported by biological plausibility. . Median age was 46 years, and time to first visit was 11 days. Cervical nodes were most frequent (51.9%), followed by supraclavicular (18.6%). Malignancy was diagnosed in 20.8% of patients, with diagnostic delay of 26.5days (15.5–42). Other specific diagnoses were established in 35.5% of cases, while 43.7% were reactive. Malignant cases were older (60.8 vs 42 years), predominantly male (68.3% vs 44.5%), had higher drug exposure (50.0% vs 29.8%), and shorter symptom duration (45 vs 90 days). In multivariable analysis, independent predictors of malignancy were: age (OR 1.71 per 10-year increase), male sex (OR 3.25), lymph node size (OR 1.36 per 5-mm increase), indurated consistency (OR 3.42), and supraclavicular location (OR 4.96). Median time to oncology evaluation was 47 days. . The QDU model enables timely diagnosis and detects malignancy in over 20% of cases. Recognizing clinical predictors may help prioritize high-risk patients and streamline diagnostic pathways.
García-Vives et al. (Sun,) studied this question.