Detection of skeletal involvement in Hodgkin's disease: a comparison of radiography, bone scanning, and bone marrow biopsy in 38 patients

As part of the staging of 38 patients with Hodgkin's disease seen over an 18-month period, we have used radioisotopic scanning of bone, as well as radiography and bone marrow biopsy, in an attempt to assess osseous and bone marrow involvement. Of the 38 patients, 14 were found to have skeletal involvement. In 11 this was histologically proved. In 8 patients, the radioisotopic scan first raised the suspicion of localized bone involvement, which was subsequently proved by bone marrow biopsy or by radiography. We believe that bone marrow involvement may at times be localized when patients with Hodgkin's disease are first staged and may precede local osseous involvement. If this is so, a reasonable approach to the search for bone marrow or osseous involvement would be to start with a bone scan and to follow this with a bone marrow biopsy from the suspicious area or a careful radiography of the same site; the latter is important if the site of increased uptake of the radionuclide is inaccessible to the biopsy needle. (U.S.)