Diagnostic procedures

The current movement towards 'minimal' staging may induce an unexpected movement, calling for 'more intensive' treatments. Indeed, some of the changes, such as the renunciation of the staging laparotomy and the lymphangiogram, make the final stage less secure and require reassuring treatments, i.e. more extensive radiotherapy or chemotherapy. This is not surprising when one considers the importance of the information that was brought by the laparotomy and the fact that laparotomy could not be replaced by any other procedure with comparable yield. The use of powerful initial prognostic factors, together with objective biological parameters, either non-specific ones coupled with long-term and adequate testing such as the ESR, albumin, blood counts, or new and promising tests such as for the soluble CD30 antigen, should make up for the loss. In addition, a dynamic approach to the disease, i.e. the repetition at reasonable intervals of initially abnormal biological, functional or imaging tests may provide the most reliable information to ensure the patient's safety.