August 6, 1973

Problems in the Staging of Hodgkin Disease

Author Affiliations

University of Wisconsin Medical Center Madison

JAMA. 1973;225(6):635. doi:10.1001/jama.1973.03220330047018

To the Editor.—  I agree in principle with Smith et al (224:1026, 1973) that a staging laparotomy may not be needed in all patients with Hodgkin disease, especially in those patients with stage I and II-A disease with favorable histology. To classify a patient as having clinical stage IV disease, however, on the basis of abnormal liver function studies or hepatomegaly, as was done by the authors preoperatively in four patients, is possibly a serious error. This has been demonstrated quite decisively by several studies, including those by Ultman1 and Givler et al.2 Ultman reported. liver biopsy studies on 120 patients who clinically had no evidence of liver involvement, four of whom were found to have Hodgkin disease in the liver. Thirty-two patients were thought to have liver involvement clinically; only three had positive liver biopsies on laparotomy.To avoid confusion in such patients it would be more