Sixty‐nine unselected, previously untreated patients with non‐Hodgkin's lymphomas underwent staging laparotomies at the Stanford University Medical Center during the years 1971 and 1972, as part of their pre‐therapy evaluation. This disclosed involvement of para‐aortic lymph nodes in 42% of these patients, splenic lymphoma in 32%, and hepatic involvement in 16%. Significantly, mesenteric lymph nodes were affected by lymphoma in 61% of the 31 patients who underwent mesenteric node biopsies. Approximately 30% of the patients changed stage as a result of the laparotomy findings. Lymphangiography demonstrated an overall accuracy of 92%. However, gastrointestinal series and barium enemas were found to be of little value in detecting subdiaphragmatic lymphoma preoperatively in asymptomatic patients, and bone marrow aspirates also correlated poorly with the presence of marrow involvement as demonstrated by biopsy. It appears therefore, that laparotomy with open iliac crest bone marrow biopsy is valuable in staging patients with non‐Hodgkin's lymphomas, but whether it will lead to better management or imporved survival must be determined by further clinical trials.
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