Role of the gallium scan in Hodgkin's disease

The reports of 240 gallium scans on 165 patients with Hodgkin's disease were reviewed to compare results with higher doses with those in earlier studies that employed lower doses. Tracer concentrations in specific sites were correlated with radiologic and pathologic reports and with the clinical courses of the patients studied. There were no significant differences in overall results between newer and older gallium scanning techniques. For untreated patients, the overall sensitivity was only 64%, but the overall specificity was 98%. For untreated patients and for patients with relapsing disease, the presence of gallium concentration in a specific site was highly predictive of active Hodgkin's disease at that site. However, for routine follow-up of treated patients, 95% of unsuspected relapses were missed by the scan, indicating the limited usefulness of negative scan results in this setting. For patients with residual abnormalities after therapy, demonstrated by other radiographic means, increased uptake of gallium in abdominal or peripheral lymph nodes also indicated active disease, although lack of uptake was reliable only in the mediastinum. Based on these results, it appears that the higher doses used in this study have not substantially improved the role of gallium scanning in this disease. Although it is potentially useful in providing confirmatory data at diagnosis or in patients with new or residual objective abnormalities after treatment, routine use of gallium scanning in Hodgkin's disease is not recommended.