DIAGNOSTIC-ACCURACY OF ULTRASOUND AND COMPUTED-TOMOGRAPHY IN THE STAGING OF HODGKINS-DISEASE - VERIFICATION BY LAPAROTOMY IN 100 CASES

Background. A staging laparotomy still is considered the gold standard to detect occult abdominal involvement in Hodgkin's disease. Computed tomography and ultrasound are routinely available for diagnostic imag ing. To the authors' knowledge, the exact contribution of ultrasound f or the staging of Hodgkin's disease has not been reported in a large s eries of patients before this study. Methods. The diagnostic accuracy of abdominal ultrasound was compared with that of computed tomography and laparotomy in 100 patients with biopsy-proven Hodgkin's disease. L iver, spleen, paraaortic, and iliac lymph nodes were evaluated separat ely. Results. Seventeen patients had a higher disease stage after surg ery (17%), Considering only patients without known abdominal disease ( supradiaphragmatic involvement), 14/79 (18%) had a positive staging la parotomy. Ultrasound had superior sensitivity for detecting splenic in volvement with Hodgkin's disease (sensitivity, 63% compared with 37% f or computed tomography). The specificity of both methods for detecting splenic disease was identical(99% vs, 96%). Inhomogeneities of struct ure or small nodular infiltrates were detected preferentially by ultra sound, Hepatic involvement also was visualized better by ultrasound th an by computed tomography. Lymph nodes at the splenic hilus were recog nized by both methods with identical sensitivity (64% vs, 62%), Paraao rtic and iliac lymph nodes were recognized with greater sensitivity by computed tomography than by ultrasound (sensitivity, 93% and 100% vs, 77% and 67%, respectively). Conclusions. These results indicate that ultrasound and computed tomography each have their weaknesses and stre ngths and therefore should be combined, if possible, Ultrasound is the fastest and least invasive method and has particular accuracy for det ecting splenic involvement, whereas computed tomography is more accura te in detecting involvement of paraaortic or iliac lymph node, If cost is important in the staging of Hodgkin's disease and if computed tomo graphy is considered the standard, patients whose results are negative by computed tomography should be examined by ultrasound, focusing on splenic texture and size. Even In the era of combined modality treatme nt, surgical staging may be necessary to detect occult abdominal disea se in a certain number of cases.