Hodgkins disease: clinical and radiological prognostic factors in a laparotomy series

From July 1979 to June 1988, 62 patients managed at Westmead Hospital underwent a staging laparotomy (LAP) for Hodgkins disease. Fifty-four patients were clinical stage (CS) I or II and eight were CS III. The sensitivities of the imaging modalities of computed tomography (CT), Gallium and bipedal lymphangiogram (LAG) were assessed for their predictive value for abdominal disease in patients who underwent a LAP. The most sensitive combination for predicting a negative laparotomy (78%) was a negative abdominal CT and a negative Gallium scan. Upstaging occurred in two of 16 Stage I patients (13%) and nine of 38 Stage II patients (24%). Of the 11 patients upstaged, the spleen was involved in 10 (91%). Factors which predicted for upstaging in a univariate analysis were: age greater than 40 years (P = 0.02), mixed cellularity or lymphocyte depleted histology (P = 0.02), and more than three sites involved above the diaphragm (P = 0.008). In a multivariate analysis, the only significant predictor was the number of sites of involvement (P = 0.007). Two subgroups who had a low probability of upstaging were favourable histology patients with up to two sites of involvement (0%) and females with up to two sites of involvement (0%). We conclude that abdominal imaging is associated with a high false-negative rate, particularly for CS II disease.