Comparison of bone and 67Ga scintigraphy in the initial diagnosis of bone involvement in children with malignant lymphoma.

The accurate staging of Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL) in children has important therapeutic and prognostic implications. The presence of secondary bone involvement or primary malignant lymphoma of bone can be determined by both radiographic and radionuclide methods. We wished to compare the relative efficacy of bone and 67Ga scintigraphy for detecting the presence of bone involvement by malignant lymphoma. We evaluated 83 children (mean age 12 years) with histologically proven HD and NHL utilizing bone and 67Ga scintigraphy which were performed prior to treatment. Three of these patients had biopsy proven primary malignant lymphoma of bone. Bone scintigraphy detected 18 bone lesions in 13 patients and 67Ga scintigraphy detected the same 18 bone lesions and in addition 101 extraosseous lesions. Radiography confirmed the presence of focal bone lesions. Both osteolytic and osteoblastic lesions were identified. We conclude that bone scintigraphy is not necessary in the initial staging of children with malignant lymphoma unless there are specific osseous symptoms. 67Ga scintigraphy is the radionuclide method of choice in the initial staging of children with malignant lymphoma.