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Problems in the Staging of Hodgkin Disease

Robert H. Kirschner, MD; Michael J. O'Connell, MD; John C. Sutherland, MD; Arthur A. Abt, MD; B. Donald Sklansky, MD; William H. Greene, MD; Peter H. Wiernik, MD
JAMA. 1973;225(6):635-636. doi:10.1001/jama.1973.03220330047019.
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To the Editor.—  We wish to comment on the article, "The Staging of Hodgkin's Disease: Selective vs Routine Laparotomy" (224:1026, 1973). Several points require discussion:

  1. The selection of which lymph nodes to biopsy is important. In addition to those listed by the authors, the largest porta hepatic lymph node should be chosen. These nodes are not reliably visualized by lymphangiography, may lie outside the usual radiation ports, and are the nodes most often involved when only solitary abdominal nodal disease is present.1

  2. Failure to discover occult abdominal disease in patients clinically stage I or II may be due to failure to biopsy nodes appearing abnormal on lymphangiography as proved by postoperative roentgenograms documenting their removal. In our experience the gross appearance of nodes at the operating table has not been reliable in predicting involvement by Hodgkin disease.

  3. Sectioning the spleen at 1-cm intervals has proved

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