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Computerised tomographic (CT) abdominal scanning in Hodgkin's disease
Insights
Computed tomography (CT) scanning shows limited value in detecting abdominal Hodgkin
Area of Science:
- Oncology
- Radiology
- Medical Imaging
Background:
- Hodgkin's disease (HD) staging requires accurate assessment of abdominal involvement.
- Conventional imaging modalities have limitations in detecting subclinical abdominal HD.
- Computed tomography (CT) scanning is a widely used imaging technique in oncology.
Purpose of the Study:
- To evaluate the efficacy of abdominal CT scanning in detecting abdominal Hodgkin's disease.
- To compare CT scanning with bipedal lymphography and surgical staging (laparotomy and splenectomy).
Main Methods:
- Thirty-nine patients with Hodgkin's disease and minimal abdominal disease evidence were included.
- Abdominal CT scans were performed and compared with bipedal lymphography.
- Results were correlated with findings from laparotomy and splenectomy.
Main Results:
- CT scanning and lymphography showed similar efficacy in assessing para-aortic lymph nodes (87% vs. 79%).
- CT scanning's sensitivity was limited by its inability to detect non-enlarged involved nodes.
- CT assessment of splenic involvement was unreliable, detecting only 1 of 11 involved spleens.
Conclusions:
- CT scanning offers limited advantage over lymphography for disease extent in this patient group.
- CT scanning is valuable for suspected abdominal relapse due to detecting non-lymphographic sites.
- CT scanning cannot yet replace staging laparotomy and splenectomy for treatment decision-making.
Abstract:
Thirty-nine patients with Hodgkin's disease (HD) with little or no clinical evidence of abdominal disease were investigated by abdominal CT scanning. The results were compared with those of bipedal lymphography and laparotomy and splenectomy. In the assessment of para-aortic lymph nodes, CT scanning and lymphography were of equal efficacy in determining the presence or absence of disease (87 and 79% respectively). Although CT scan could occasionally demonstrate disease in nodes in areas other than the retroperitoneum, its value was limited by its inability to detect involvement of nodes which were not significantly enlarged. CT assessment of splenic HD was unreliable, focal deposits being detected in only one of the 11 spleens involved. In this selected group of patients, CT scan had little advantage over lymphography in the description of disease extent. However, CT scan would appear to be the investigation of choice in patients with suspected abdominal relapse because of the more frequent presence of disease in sites not seen on lymphography. When treatment decisions are dependent on accurate knowledge of distribution of disease, CT scanning cannot yet effectively replace staging laparotomy and splenectomy as the means of achieving this information.