The significance of a uniform definition of pathological lymph nodes in Hodgkin lymphoma: impact of different thresholds for positive lymph nodes in CT imaging on staging and therapy.
OBJECTIVE
The most commonly used approach for the assessment for differentiating malignant versus reactive lymph nodes is the measurement of the cross-section diameter of the lymph nodes in the transversal CT-planes. The intention of this article is to assess the impact of varying definitions of pathological lymph node size in CT-imaging in patients with Hodgkin lymphoma and to evaluate its effect on staging, chemotherapy regimes and radiation field size.


METHODS
Pretherapeutic CT-scans of 10 consecutive patients with Hodgkin lymphoma have been evaluated based on two different definitions for malignant lymph node size; the classification of the German study group for Hodgkin lymphoma (1.0 cm) and the classification according to the results of the Cotswold consensus meeting 1989 (1.5 cm).


RESULTS
Applying the definitions of the DHSG and the Cotswold meeting we found more affected lymph node regions compared to the evaluation of the referring institutions in 9/10 and 6/10 patients, higher stages in 2/10 and 1/10 patients, more intense chemotherapy regimes in 3/10 and 1/10 and larger radiation fields in 10/10 and 6/10 patients, respectively.


CONCLUSIONS
Varying definitions of pathologic lymph node size and inconsequent application of definitions reduce the comparability between different studies and within each study.
Vorwerk
Hilke
H
Department of Radiotherapy, University of Göttingen, Göttingen, Germany. h.vorwerk@med.uni-goettingen.de
Obenauer
Silvia
S
Schmidberger
Heinz
H
Hess
Clemens F
CF
Weiss
Elisabeth
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D006689:Hodgkin Disease / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed