A comparison of staging methods for Hodgkin's disease in children
K. P. Lally, M. Arnstein, S. Siegel, J. H. Miller, V. Gilsanz, L. Ettinger and J. B. Atkinson
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.