Abdominal staging of thoracic Hodgkin disease: CT-lymphangiography-Ga-67 scanning correlation.

Abstract

A retrospective study was performed to assess whether lymphangiography and gallium-67 scanning were complementary to computed tomography (CT) in abdominal staging of disease in 94 patients with early-stage thoracic Hodgkin disease. In 51 patients with surgical or follow-up correlation, the spleen was involved in 16% (n = 8), the spleen and lymph nodes in 22% (n = 11), and only lymph nodes in 2% (n = 1). In these 51 patients, none of the imaging modalities had greater than 50% sensitivity for the detection of nodal involvement. The overall accuracy was similar (71%-82%) for each modality. Analysis of subgroups of patients with lymph nodes measuring less than 10 mm, 10-19 mm, or 20 mm or greater at CT revealed that lymphangiography and gallium scanning added little to the positive or negative predictive values of CT. The sensitivity of CT for detection of splenic disease was 11% (two of 19). On the basis of surgical or follow-up correlation in 51 patients, the authors conclude that lymphangiography and gallium scanning offer minimal or no complementary benefit.

FDG-PET is Superior to Gallium Scintigraphy in Staging and More Sensitive in the Follow-up of Patients withde novoHodgkin Lymphoma: A Blinded Comparison

“…Perhaps more importantly, nuclear scintigraphy may help to characterize a residual mass Currently, standard nuclear imaging for Hodgkin lymphoma utilizes gallium-67 citrate, which binds to the transferrin receptor. The role of gallium scintigraphy in the staging of Hodgkin lymphoma remains controversial [14 -16], particularly if it is performed without SPECT, which may limit the detection of abdominal disease [17]. Numerous studies suggest that residual gallium avidity during or following therapy portends a high risk of relapse [3,18 -20], particularly in mediastinal disease [1].…”

Comparison of positron emission tomography and lymphangiography in the diagnosis of infradiaphragmatic hodgkin's disease

“…For instance, STRIJK et al reported a discrepancy of about 25% between CT and LAG, mainly due to a normal CT finding and an abnormal LAG finding (15,16). In contrast, some other studies have reported that LAG disclosed very little information in HD when compared with CT, and that its predictive value was no more than 5% in small lymph nodes (6,14).…”

“…With the newer generation of helical and multislice CT scanners, the upper limits of normal lymphnode size have decreased, and recognized limits are now about 10 mm, depending on the lymph-node location and the balance between false-positive and false-negative results desired by physicians (2,14,17). As a result of the improved imaging capabilities of CT, close agreement for negative findings between CT and LAG has been reported (8,9,13), and the practice of LAG has been abandoned by many radiologists and clinicians.…”

“…However, no tissue verification was performed for ethical and practical reasons, and false positives of LAG could also be evoked. Indeed, several studies that have compared LAG to staging laparotomy have reported a significant rate of LAG false positives, from 20% (7) to 70% (4) or 80% (5), mainly due to benign reactive hyperplasia, and for STOMPER et al true-positive LAG findings were seen only when lymph-node size was above 10 mm (14).…”

Role of 67 Ga scintigraphy in localization of lymphoma

“…Most 67 Ga scans for evaluation and staging of lymphomas should be performed 48-72 h after injection of the radiopharmaceutical, when blood pool clearance of the agent has nearly been completed, and the activity in the colon has had the opportunity to be evacuated. Lesions less than 2 cm in diameter can be missed because they are below the detection limit of the imaging system [7][8][9]. Detection of tumors larger than 5 cm may be hampered because they are likely to have necrotic centers that do not accumulate 67 Ga.…”