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Wertigkeit klinischer Untersuchungsmethoden zur Stadieneinteilung beim abdominellen Morbus Hodgkin

Diagnostic value of clinical methods in the staging of abdominal Hodgkin's disease

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Summary

Explorative laparotomies were carried out on 68 patients with Hodgkin's disease in the University Hospital of Marburg from 1969 through 1978. These laparotomies were preceded by clinical examination, abdominal sonography in 27 cases, lymphography in 55 cases, scintigraphy of liver and spleen in 58 cases, and radiographic examinations of the intestinal tract in 18 cases.

Sonography revealed a greater accuracy (90%) for splenic involvement than scintigraphy (74%); the results of sonography and scintigraphy of the liver were comparable. For the detection of para-aortal lymphomas ultrasound and lymphography can be regarded as complementary methods.

Our results are compared with findings in the literature on abdominal sonography (n=50), scintigraphy of liver and spleen (n=185), and lymphography (n=465) carried out before explorative laparotomy for lymphogranulomatosis.

There was a better correlation for the systemic symptoms of the 68 patients with the clinical stage than with the pathologic stage.

The importance of diagnosing prognostic different groups, e.g. in stage III, is stressed.

Zusammenfassung

Von 1969 bis 1978 wurden an den Universitätskliniken in Marburg 68 Laparotomien zur Stadieneinteilung beim M. Hodgkin durchgeführt. Voraus gingen eine klinische Untersuchung, in 27 Fällen eine Lymphographie, in 58 Fällen eine Leber-Milz-Szintigraphie und in 18 Fällen eine Röntgenuntersuchung des Intestinaltraktes.

Die Allgemeinsymptomatik der 68 Patienten korrelierte besser mit dem pathologischen als mit dem klinischen Stadium.

Die Ultraschalluntersuchung ergab für den Milzbefall eine höhere Treffsicherheit (90%) als die Szintigraphie (74%); für den Leberbefall erwiesen sich Sonographie und Leberszintigraphie gleichwertig. Für die Erkrankung paraaortaler Lymphknoten sind Lymphographie und Ultraschalldiagnostik als einander ergänzend anzusehen. Unsere Ergebnisse werden mit den Mitteilungen der Literatur über abdominelle Sonographie (n=50), Leber-Milz-Szintigraphie (n=185) und Lymphographie (n=465) verglichen. Auf die Bedeutung prognostisch unterschiedlicher Gruppen z. B. im Stadium III wird hingewiesen.

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Literatur

  1. Aisenberg, A.C., Gloman, J.M., Raker, J.W., Wang, C.C.: Spleen involvement at the onset of Hodgkin's disease. Ann. Intern. Med.74, 544 (1971)

    Google Scholar 

  2. Alcorn, F.S., Mategrano, V.C., Petasnick, J.P., Clark, J.W.: Contributions of computed tomography in the staging and management of malignant lymphomas. Radiology125, 717–723 (1977)

    Google Scholar 

  3. Antoniades, J., Groll, M.N., Walner, R.J., Brady, L.W.: Serial liver and spleen scanning in patients with malignant lymphomas. Radiology45, 372 (1976)

    Google Scholar 

  4. Asher, W.M., Freimanis, A.K.: Echographic diagnosis of retroperitoneal lymph node enlargement. Am. J. Roentgenol.105, 438 (1969)

    Google Scholar 

  5. Begemann, H.: Die Splenektomie bei Lymphogranulomatose-(Hodgkin)-Kranken. Med. Klin.70, 591 (1975)

    Google Scholar 

  6. Breiman, R.S., Castellino, R.A., Harell, G.S., Marshall, W.H., Glatstein, E., Kaplan, H.S.: CT-Pathologic correlations in Hodgkin's disease and non Hodgkin's lymphoma. Radiology126, 159–166 (1978)

    Google Scholar 

  7. British National Lymphoma Group-Cobbold Laboratories. The Middlesex Hospital London: The value of laparotomy and splenectomy in the management of early Hodgkin's disease. Clin. Radiology26, 151–157 (1975)

    Google Scholar 

  8. Carbone, P.P., Kaplan, H.S., Musshoff, K., Smithers, D.W., Tubiana, M.: Report of the committee on Hodgkin's disease staging classification. Cancer Res.31, 1860 (1971)

    Google Scholar 

  9. Castellino, R.A., Blank, N.: Roentgenologic aspects of Hodgkin's diseases: I. Current role of lymphangiography. Natl. Cancer Inst. Monogr.36, 271–276 (1973)

    Google Scholar 

  10. Chilcote, R.R., Baehner, R.L., Hammond, D., and the investigators and special studies committee of the children's cancer study group: Septicemia and meningitis in childrens splenectomized for Hodgkin's disease. N. Engl. J. Med.295, 798 (1976)

    Google Scholar 

  11. Czembirek, H., Neumann, E., Haydl, J., Howanietz, L., Jantsch, Ch., Pantucek, F., Pokieser, H.: Angiographie, Szintigraphie und Ultraschall zum Nachweis von Milz-oder Leberbefall bei Morbus Hodgkin. Fortschr. Röntgenstr.123, 403 (1975)

    Google Scholar 

  12. Desser, R.K., Golomb, H.M., Ultmann, J.E., Ferguson, D.J., Moran, E.M., Griem, M.L., Vardiman, J., Miller, B., Oetzel, N., Sweet, D., Lester, E.P., Kinzie, J.J., Blough, R.: Prognostic classification of Hodgkin's disease in pathologic stage III based on anatomic considerations. Blood49, 833–893 (1977)

    Google Scholar 

  13. Diehl, V., Schaadt, M., Kalden, R.J., Schmidt, N., Deinhardt, J.: Der Einfluß der Splenektomie auf den Immunstatus von Hodgkin-Patienten. Klin. Wochenschr.56, 809 (1978)

    Google Scholar 

  14. Dorfman, R.F.: Relationship of histology to site in Hodgkin's disease. Cancer Res.31, 1786–1793 (1971)

    Google Scholar 

  15. Ehrlich, A.N., Stalder, G., Geller, W., Sherlock, P.: Gastrointestinal manifestations of malignant lymphoma. Gastroenterology54, 1115 (1968)

    Google Scholar 

  16. Ell, P.J., Britton, K.E., Farrer-Brown, G., Keeling, D.H., Jeliffe, A.M., Wood, T.P.: An assessment of the value of spleen scanning in the staging of Hodgkin's disease. Br. J. Radiology48, 590–593 (1975)

    Google Scholar 

  17. Erbe, W., Wiebe, V., Freisenhausen, H.D.: Die Wertigkeit radiologischer Maßnahmen zur Stadieneinteilung maligner Lymphome. Verh. Dtsch. Ges. Inn. Med.79, 500 (1973)

    Google Scholar 

  18. Fischer, M., Mitrou, P.S., Hübner, K., Hank, H., Lennert, K.A.: Die Splenektomie bei Morbus Hodgkin. Dtsch. Med. Wochenschr.99, 1402–1405 (1974)

    Google Scholar 

  19. Fischer, J.: Explorative Laparotomie und Splenektomie beim Morbus Hodgkin. Hematol. Bluttransfus.18, 89 (1976)

    Google Scholar 

  20. Fülle, H.H., Pribilla, W.: Explorative Laparotomie und Splenektomie bei Lymphogranulomatose. Schweiz. Med. Wochenschr.104, 413 (1974)

    Google Scholar 

  21. Glatstein, E., Trueblood, W., Enright, L.P., Rosenberg, S.A., Kaplan, H.S.: Surgical staging of abdominal involvement in unselected patients with Hodgkin's disease. Radiology97, 425 (1978)

    Google Scholar 

  22. Glees, J.P., Gazet, J.-C., MacDonald, J.S., Peckham, M.J.: The accuracy fo lymphography in Hodgkin's disease. Clin. Radiology25, 5–11 (1974)

    Google Scholar 

  23. Glees, J.P., Taylor, K.J.W., Gazet, J.-C., Peckham, M.J., McCready, V.R.: Accuracy of grey-scale ultrasonography of liver and spleen in Hodgkin's disease and the other lymphomas compared with isotope scans. Clin. Radiol.28, 233–238 (1977)

    Google Scholar 

  24. Goffinet, D., Glatstein, E.J., Merigam, T.C.: Herpes zoster-varicella infections and lymphoma. Ann. Intern. Med.76, 235–240 (1972)

    Google Scholar 

  25. Haas, A.C., Brunk, S.F., Gulesserian, H.P., Gilver, R.C.: The value of exploratory laparotomy in malignant lymphoma. Radiology101, 157–161 (1971)

    Google Scholar 

  26. Hancock, B.W., Bruce, L., Ward, A.M., Richmond, J.: The immediate effects of splenectomy, radiotherapy, and intensive chemotherapy on the immune status of patients with malignant lymphoma. Clin. Oncol.3, 137–144 (1977)

    Google Scholar 

  27. Hanks, G.E., Terry, L.N., Brynn, J.A., Newsome, J.F.: Contribution of diagnostic laparotomy to staging non-Hodgkin's lymphoma. Cancer29, 41–50 (1972)

    Google Scholar 

  28. Hoffken, K., Schmidt, C.G.: Laparoskopie bei Morbus Hodgkin. Dtsch. Med. Wochenschr.101, 814 (1976)

    Google Scholar 

  29. Ibrahim, E., Fuller, L.M., Gamble, J.F.: Stage I Hodgkin's disease: Comparison of surgical staging with incidence of new manifestations in lymphogram-studied patients. Radiology104, 145–151 (1972)

    Google Scholar 

  30. Jeliffe, A.M., Millet, Y.L., Marston, J.A.P., Bennett, M.H., Farrer-Brown, G., Kendall, B., Keeling, D.H.: Laparotomy and splenectomy as routine investigations in the staging of Hodgkin's disease before treatment. Clin. Radiology21, 439 (1970)

    Google Scholar 

  31. Kaplan, H.S., Dorfman, R.F., Nelsen, T.S., Rosenberg, S.A.: Staging laparotomy and spienectomy in Hodgkin's disease: Analysis of indications and patterns of involvement in 285 consecutive, unselected patients. Natl. Cancer Inst. Monogr.36, 291 (1973)

    Google Scholar 

  32. Kaplan, H.S., Rosenberg, S.A.: The management of Hodgkin's disease. Cancer36, 796–803 (1975)

    Google Scholar 

  33. Kresse, H.: Sonographie: Methodisch physikalische Grundlagen — Apparaturen. Internist17, 530–548 (1976)

    Google Scholar 

  34. Lee, Y.-T.N., Spratt, J.S.: Malignant lymphoma: nodal and extranodal diseases. New York, London: Grüne & Stratton 1974

    Google Scholar 

  35. Levi, J.A., Wiernik, P.H.: The therapeutic implications of splenic involvement in stage IIIA Hodgkin's disease. Cancer39, 2158–2165 (1977)

    Google Scholar 

  36. Levitan, R.: Unrelated gastrointestinal disorders in patients with generalized Hodgkin's disease. Am. J. Dig. Dis.4, 307 (1966)

    Google Scholar 

  37. Levitt, R.G., Jost, R.G., Trachtmann, J., Sagel, S.S., Stanley, R.J.: A computer-assisted method to determine the diagnostic efficacy of computed tomography of the body. Radiol.123, 97 (1977)

    Google Scholar 

  38. Lowenbraun, S., Ramsey, H.E., Serpick, A.A.: Splenectomy in Hodgkin's disease for splenomegaly, cytopenias and intolerance to myelosuppressive chemotherapy. Am. J. Med.50, 49 (1971)

    Google Scholar 

  39. Lukes, R.J., Craver, L.F., Hall, T.C., Rappaport, H., Rubin, P.: Report of the nomenclature committee. Cancer Res.26, 1211 (1966)

    Google Scholar 

  40. Lutz, H., Petzoldt, R.: Ultraschall in der Tumordiagnostik. Strahlentherapie154, 463–467 (1978)

    Google Scholar 

  41. Marshall, W.H., Breiman, R.S., Harell, G.S., Glatstein, E., Kaplan, H.S.: Computed tomography of abdominal paraaortic lymph node disease: preliminary observations with a 6-second scanner. Am. J. Roentgenol.128, 759–764 (1977)

    Google Scholar 

  42. Mitchell, R.J., Peters, M.V., Brown, T.C., Rideout, D.: Laparotomy for Hodgkin's disease: some surgical observations. Surgery71, 694–703 (1972)

    Google Scholar 

  43. Musshoff, K., Slanina, J.: Maligne Systemerkrankungen. In: Strahlentherapie. Radiologische Onkologie. Scherer, E. (Hrsg.) Berlin, Heidelberg, New York: Springer 1976

    Google Scholar 

  44. Neidhardt, B., Hartwich, G., Schwemmle, K., Hermanek, P., Seiler, G.: Explorative Laparotomie und Splenektomie bei Lymphogranulomatose. Dtsch. Med. Wochenschr.100, 1487 (1975)

    Google Scholar 

  45. Pemsel, H.K., Jacobs, C., Heß, F., Kalbfleisch, H.: Die Allgemeinsymptomatik bei der Hodgkin'schen Erkrankung in ihrer Zuordnung zu anderen prognostischen Kriterien. Strahlentherapie154, 758 (1978)

    Google Scholar 

  46. Prosnitz, L.R., Nuland, S.B., Kligerman, M.N.: Role of laparotomy and splenectomy in the management of Hodgkin's disease. Cancer29, 44–50 (1972)

    Google Scholar 

  47. Rasmussen, S.N., Holms, H.H., Kristensen, J.K., Barlebo, H.: Ultrasonically guided liver biopsy. Br. Med. J.2, 500 (1972)

    Google Scholar 

  48. Redman, H.C., Giatstein, E., Castellino, R.A., Rederal, W.A.: Computed tomography as an adjunct in the staging of Hodgkin's disease and non-Hodgkin's lymphomas. Radiology124, 381–387 (1977)

    Google Scholar 

  49. Reed, D.M.: On the pathologic changes in Hodgkin's disease, with special reference to its relation to tuberculosis. John Hopkins Hosp. Rep.10, 133–196 (1902)

    Google Scholar 

  50. Rettenmaier, G.: Sonografischer Oberbauchstatus. Internist17, 549–564 (1976)

    Google Scholar 

  51. Richmond, J., Sherman, R.S., Diamond, H.D., Craver, L.F.: Renal lesions associated with malignant lymphomas. Am. J. Med.32, 184 (1962)

    Google Scholar 

  52. Rochester, D., Bowle, J.D., Kunzmann, A., Sester, E.: Ultrasound in the staging of lymphoma. Radiology124, 483 (1977)

    Google Scholar 

  53. Rosenberg, S.A., Kaplan, H.S., Giatstein, E.J., Portlock, C.S.: Combined modality therapy of Hodgkin's disease. Cancer [Suppl.]42, 991 (1978)

    Google Scholar 

  54. Schimpff, S.C., O'Connell, M.J., Greene, W.H., Wiernik, P.H.: Infections in 92 splenectomized patients with Hodgkin's disease. Am. J. Med.59, 695 (1975)

    Google Scholar 

  55. Silverman, S., De Nardo, G.L., Giatstein, E., Lipton, M.J.: Evaluation of the liver and spleen in Hodgkin's disease. II The value of splenic scintigraphy. Am. J. Med.52/3, 263 (1972)

    Google Scholar 

  56. Staib, J., Kaiser, D.: Laparotomie und Splenektomie bei Lymphogranulomatose. Internist15, 79–84 (1974)

    Google Scholar 

  57. Stanley, R.J., Sagel, S.S., Levitt, R.G.: Computed tomography of the body: early trends in application and accuracy of the method. Am. J. Roentgenol.127, 53–67 (1976)

    Google Scholar 

  58. Stephens, D.H., Sheedy, P.F., Hattery, R.R., Williamson, B.: Diagnosis and evaluation of retroperitoneal tumors by computed tomography. Am. J. Roentgenol.129, 396–402 (1977)

    Google Scholar 

  59. Strum, S.B., Rappaport, H.: Interrelations of the histologic types of Hodgkin's disease. Arch. Pathol.91, 127 (1971)

    Google Scholar 

  60. Sweet, D.L., Kinnealy, A., Ultmann, J.E.: Hodgkin's disease: problems of staging. Cancer42, 957–970 (1978)

    Google Scholar 

  61. Taylor, K.J.W., McCready, V.R.: A clinical evaluation of grey-scale ultrasonography. Br. J. Radiology49, 244–252 (1976)

    Google Scholar 

  62. Taylor, K.J.W., Milan, J.: Differential diagnosis of chronic splenomegaly by grey-scale ultrasonography: clinical observations and digital A-scan analysis. Br. J. Radiology49, 519–525 (1976)

    Google Scholar 

  63. Teillet, F., Boiron, Bernard, J.: A reappraisal of clinical and biological signs in staging of Hodgkin's disease. Cancer Res.31, 1723 (1971)

    Google Scholar 

  64. Ultman, J.E.: Report on workshop: clinical evaluation, staging, and prognosis. Natl. Cancer Inst. Monogr.36, 355–356 (1973)

    Google Scholar 

  65. Zaunbauer, W., Haertel, M., Fuchs, W.A.: Die diagnostische Zuverlässigkeit der Lymphographie beim Morbus Hodgkin. Fortschr. Röntgenstr.126, 1–5 (1977)

    Google Scholar 

  66. Zarembok, I., Ramsey, H.E., Sutherland, J., Serpick, A.A.: Laparotomy and splenectomy in the staging of untreated patients with Hodgkin's disease. Radiology102, 673 (1972)

    Google Scholar 

  67. Zum Winkel, K.: Nuklearmedizin. Berlin, Heidelberg, New York: Springer 1975

    Google Scholar 

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Authors and Affiliations

  1. Medizinische Klinik der Philipps-Universität Marburg, Mannkopffstraße 1, D-3550, Marburg, Bundesrepublik Deutschland

    S. L. Roth, H. Dombrowski & W. B. Schwerk

  2. Chirurgische Klinik der Philipps-Universität Marburg, D-3550, Marburg

    D. Maroske

  3. Medizinische Poliklinik der Philipps-Universität Marburg, D-3550, Marburg

    W. D. Gassel

  4. Pathologisches Institut der Philipps-Universität Marburg, D-3550, Marburg

    P. Schmitz-Moormann

  5. Medizinisches Zentrum für Radiologie der Philipps-Universität Marburg, D-3550, Marburg

    F. Heß, K. Joseph & K. P. Riester

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  1. S. L. Roth
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Roth, S.L., Dombrowski, H., Gassel, W.D. et al. Wertigkeit klinischer Untersuchungsmethoden zur Stadieneinteilung beim abdominellen Morbus Hodgkin. Blut 40, 123–135 (1980). https://doi.org/10.1007/BF01013695

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