Staging in childhood non-Hodgkin's lymphoma. What are its benefits? How extensive should it be?

A review of published reports of the management of childhood non-Hodgkin's lymphoma was undertaken to determine the extent to which a staging procedure should be implemented and the benefits which could be derived. A variety of clinical, radiographic, surgical, and laboratory investigations were performed by different investigators. Overall, similar results were obtained for the different stages. The utility of the individual studies was not defined in any single review. However, it appeared that bone marrow biopsy was superior to bone marrow aspirates, staging laparotomy was generally not required, and lymphangiography did not constitute a routine staging procedure. Staging permitted identification of patients with primary sites at high risk for the development of central nervous system disease or failure. The reviews did not specify the minimum number of procedures to be performed. It is concluded that each patient should receive individual consideration, and diagnostic evaluation should consist of a series of tests sequentially performed and interrupted whenever sufficient information has been assembled for institution of therapy.