How to restrict liver biopsy to high-risk patients in early-stage Hodgkin's disease

Liver biopsy is an invasive diagnostic method for detecting liver involveme nt (LI) in Hodgkin's disease (HD). The aim of this retrospective study was to determine and evaluate a method for restricting liver biopsy to a subset of patients. Between 1988 and 1994, a total of 2016 patients with HD were treated within the HD4-6 study protocol of the German Hodgkin's Lymphoma St udy Group (GHSG). We investigated the predictive power of abdominal ultraso und (US) and computed tomography (CT), as well as of various clinical facto rs related to LI, using univariate and multivariate methods. LI occurred in 4.9% of all patients (99/2016) and in 3.0% of those who, if LI were disreg arded, would have been included in clinical stages I and II. In multivariat e analysis the presence of LI was significantly associated with splenic inv olvement or infradiaphragmatic involvement, absence of mediastinal involvem ent, serum alkaline phosphatase (SAP) level over 230 units/l, and age over 40 years. We used these factors to define a risk score for LI. LI is very r are in patients who would otherwise be in clinical stages I or II, but know ledge of LI is important because it has therapeutic consequences. With our risk score, liver biopsy is indicated for approximately one quarter of thes e patients otherwise in clinical stages I or II.