Assessment of residual posttreatment masses in Hodgkin's disease and the need for biopsy in children.
BACKGROUND
In children with Hodgkin's disease (HD), a significant residual mass may remain after definitive treatment. It may be composed of necrotic/fibrous tissue or resistant HD. Various imaging modalities are available to assess this mass, including chest x-ray (CXR), computed tomographic (CT) scan, and gallium scan. Our aim was to determine the sensitivity and specificity of each modality for residual HD.


METHODS
Two hundred fifty-six children with HD during 1985 to 2003 were retrospectively reviewed.


RESULTS
Twenty-six patients with HD had residual masses at end of therapy, deemed to be of concern for residual disease. These children had 16 abnormal CXRs, 18 abnormal CT scans, and 9 abnormal gallium scans; all patients underwent biopsy. Ten (38%) showed resistant HD and 16 (62%) had fibrotic and necrotic tissue. The sensitivity and specificity of each imaging modality were 60% and 38% for CXR, 67% and 8% for CT scan, and 71% and 71% for gallium scan, respectively.


CONCLUSIONS
These imaging modalities were not sufficiently sensitive or specific to predict which residual masses may be harboring resistant HD. Hence, the need for surgical biopsy will remain important in the assessment of these masses. FDG-PET scan, which was not available to these children, is a modality that may improve this assessment.
Nasr
Ahmed
A
Division of General Surgery, Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8.
Stulberg
Jennifer
J
Weitzman
Sheila
S
Gerstle
J Ted
JT