Routine bone scintigraphy is of limited value in the clinical assessment of untreated patients with Hodgkin's disease

The aim of this retrospective study was to evaluate the role of routinely p erformed bone scintigraphy in the clinical assessment of patients with prev iously untreated Hodgkin's disease (HD). One-hundred and eighty-three patients with a median age of 31 yrs (range 16 -85) with newly diagnosed HD underwent bone scintigraphy between 1972 and 1 995. Bone scintigraphies and skeletal X-ray examinations of patients with a ny pathological scintigraphic finding were reassessed. Initially HD bone involvement could be excluded in 173 (95%) of the patient s. Among the remaining ten patients, two had diffuse increased tracer uptak e but X-rays were normal. One of these patients was classified as normal wi th regard to HD bone involvement. A bone marrow scintigraphy examination an d regression of changes following therapy supported primary osseous involve ment in the other patient. Five patients had focal scintigraphic abnormalit ies but skeletal X-rays remained negative; three of these five patients rep orted pain in the scintigraphically affected areas, and therefore the suspi cion of bone involvement was strong. The remaining three patients had focal findings both on bone scintigraphy and skeletal X-ray examination and were considered as having osseous HD involvement. All seven patients judged to have HD bone involvement were planned to receive combination chemotherapy u p-front, irrespective of the scintigraphic findings. In this series of 183 patients bone involvement was detected in seven patie nts based on bone scintigraphy/symptoms (n=3), bone marrow scintigraphy/sym ptoms (n=1), and bone scintigraphy/X-ray examination (n=3), The decision to give multiagent chemotherapy to all patients was not influenced by scintig raphic findings. Therefore, routine bone scintigraphy seems to be of limite d value in the clinical assessment of untreated patients with HD.