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Kevin P. Lally, MD; Michael Arnstein; Stuart Siegel, MD; John H. Miller, MD; Vicente Gilsanz, MD; Lawrence Ettinger, MD; James B. Atkinson, MD

Arch Surg. 1986;121(10):1125-1127.

Abstract
• Potential long-term complications of radiotherapy and chemotherapy in the pediatric patient with Hodgkin's disease necessitate accurate staging. To determine the accuracy of abdominal computed tomography (CT) and gallium citrate Ga 67 scans in staging Hodgkin's disease, we reviewed the charts of all children with Hodgkin's disease seen at Childrens Hospital of Los Angeles from 1975 to 1985. Patients with pathologically proved stage IV disease (ie, bone marrow involvement) and those who only underwent staging laparotomy were excluded. A total of 40 children underwent staging by laparotomy and staging by abdominal CT and/or ⁶⁷Ga scan. The CT and ⁶⁷Ga scans were reviewed by radiologists in a blinded manner and compared with the results of a formal staging laparotomy. Of the 38 patients whose disease was staged with ⁶⁷Ga scan, disease in ten was understaged and in four overstaged, for a 37% incorrect staging rate. Of the 14 patients whose disease was staged by CT scan, disease in three was understaged and in one overstaged, for a 29% incorrect staging rate. In view of the inaccuracy of noninvasive studies and the impact of incorrect staging on treatment, we recommend that a staging laparotomy be performed in all children with Hodgkin's disease who are not proved to have stage IV disease.

(Arch Surg 1986;121:1125-1127)

Author Affiliations
From the Divisions of Pediatric Surgery (Drs Lally and Atkinson and Mr Arnstein), Radiology (Drs Miller and Gilsanz), and Hematology-Oncology (Drs Siegel and Ettinger), Childrens Hospital of Los Angeles; and the University of Southern California School of Medicine, Los Angeles (Drs Lally, Siegel, Miller, Gilsanz, Ettinger, and Atkinson and Mr Arnstein).

Footnotes
Accepted for publication June 10, 1986.

Read before the Annual Meeting of the Southern California Chapter of the American College of Surgeons, Palm Springs, Calif, Jan 19, 1986.

Reprint requests to Division of Pediatric Surgery, Childrens Hospital of Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027 (Dr Atkinson).

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