R. Munker et al., DIAGNOSTIC-ACCURACY OF ULTRASOUND AND COMPUTED-TOMOGRAPHY IN THE STAGING OF HODGKINS-DISEASE - VERIFICATION BY LAPAROTOMY IN 100 CASES, Cancer, 76(8), 1995, pp. 1460-1466
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.