EMERGING ROLE OF LAPAROSCOPY IN THE DIAGNOSIS OF LYMPHOMA

Purpose: The results of laparoscopic procedures on patients with suspe cted or known lymphoma were analyzed to review the application and def ine the role of laparoscopy in lymphoma. Patients and Methods: The hos pital records of 94 patients who underwent 101 procedures between June 1993 and October 1996 were reviewed for demographic and clinicopathol ogic information. Results: The procedure was diagnostic in 85 patients , either at primary presentation (48 patients), possible relapse (21 p atients), in the course of treatment (eight patients), or of a liver l esion (eight patients). In the remaining 16 patients, it was used to s tage possible intraabdominal disease. Twenty-seven patients had a prev ious unsuccessful diagnostic procedure. There were no operative deaths and eight postoperative complications (8%). The laparoscopy revealed non-Hodgkin's lymphoma (NHL) in 48 patients, Hodgkin's disease (HD) in 14 patients, other neoplastic conditions in six patients, and benign conditions in 33 patients. There was adequate information in all proce dures in which lymphoma was diagnosed for treatment decisions. There w as one false-negative and one nonresult for technical reasons. Ten pat ients commenced chemotherapy before discharge after a median delay of 3.5 days. In five of 24 patients (21%) with recurrent or persistent ly mphoma, the precise diagnosis was significantly different from the ori ginal one. Conclusion: From our experience, laparoscopy can safely pro vide tissue samples of suspected lymphoma for full diagnostic analysis . It should be considered when percutaneous biopsy is not technically possible, when chromosomal or genetic analysis is needed for treatment decisions, or when the results of percutaneous biopsy are inadequate to make therapeutic decisions.