Problems of interpretation of liver biopsy in Hodgkin's disease

Review of 115 autopsy cases of Hodgkin's disease showed hepatic involvement in 73 patients (63%). Review of 86 liver biopsy specimens from 65 patients with Hodgkin's disease disclosed hepatic involvement in 9 patients (14%). Pre‐biopsy evaluation of the liver was in disagreement with biopsy findings in about one third of the patients; alkaline phosphatase was the most sensitive parameter evaluated and liver scan the least sensitive. All positive liver biopsies were wedge specimens, most obtained from areas considered grossly suspicious by the surgeon. Despite modern staging methods, the liver remains a “blind area” and inspection of the liver by the surgeon at laparotomy is a valuable staging technique. Ten patients with liver biopsy had hepatic lesions lacking Sternberg‐Reed cells but otherwise consistent with Hodgkin's disease. In view of the profound effect of liver biopsy findings on therapy decisions, it is recommended that diagnostic certainty be reserved for hepatic lesions containing Sternberg‐Reed cells.