The staging of Hodgkin's disease

The approach to staging patients with Hodgkin's disease has changed over the last 20 years. Although careful physical examination, chest radiograph, and bipedal lymph-angiogram remain the mainstays of the clinical evaluation, computed tomography (CT) scanning of the chest and abdomen is rapidly gaining acceptance as a useful ancillary procedure. In addition, the initial enthusiasm for the staging laparotomy and splenectomy as a necessary part of the staging evaluation is now coming into question. Recent studies raise legitimate concerns about this procedure's overall impact upon survival as well as the potential long-term consequences of splenectomy. Select situations do exist, however, where a staging laparotomy remains appropriate. An approach to the staging of newly diagnosed Hodgkin's disease is suggested and supported by recent studies of this disease.