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» Expert Histio Net » For Professionals » Guidelines » LCH adult » Pretreatment clinical evaluation » Laboratory / Radiographic evaluation  · 

Laboratory and radiographic evaluation

Author(s): Euro Histio Net Work Group for LCH Guidelines for adults (see introduction page), Created: 2012/07/26, last update: 2014/02/09

The laboratory tests to be performed for all patients independently of affected organs include a complete blood count, blood chemistry, coagulation studies, thyroid stimulating hormone (TSH), freeT4 and urine analysis - see table 3).(Grade D2 *).

A skeletal survey, skull series (or low dose whole bone CT [McClain 2011]) and chest x-ray (AP and lateral) are the first radiographic examinations to be done. CT of specific areas of the skeleton are indicated when mastoid, orbital, scapular, vertebral, or pelvic lesions are found by plain x-rays. MRI may detect additional osseous or extraosseous lesions. A skeletal scintigram (bone scan) alone does not suffice.

Any evidence of a pathological thoracic finding should be followed up by high-resolution chest CT. Ultrasonographic examination of the abdomen may reveal hepatic abnormalities. An ultrasound of the neck with attention to the thyroid gland may be indicated if there are thyroid nodules or evidence of thyroid dysfunction. A MRI of head is needed for hypothalamic/pituitary or brain abnormalities. PET-(CT) scan may identify lesions missed by other modalities and documents response to therapy [Phillips et al 2009].

Tab. 3. Baseline la­bo­rato­ry and ra­dio­gra­phic eva­lua­ti­on

 
  

Recommendation

Grade*

  • Full Blood Count (Hemoglobin, White blood cell and differential count, Platelet count)

D2

  • Blood Chemistry (Total protein, Albumin, Bilirubin , ALT (SGPT), AST (SGOT)

D2

  • Alkaline phosphatase (AP), gammaglutamyl transpeptidase (γGT)
 
  • Creatinine, Electrolytes, CRP (C-reactive Protein)
 
  • Erythrocyte Sedimentation Rate (ESR)

D1

  • Coagulation Studies (INR/PT, Fibrinogen)

D2

  • Thyroid Stimulating Hormone (TSH), freeT4

D2

  • Morning Urine Osmolarity

D1

  • Urine Test Strip

D2

  • Ultrasound (liver, spleen, lymph-nodes, thyroid gland)

D2

  • Chest Radiograph (CXR)

D2

  • Low Dose Whole Body (Bone) CT (if not available: X-Ray Skeletal/Scull Survey)

D2

  • Optional: Baseline Head-MRI

D2

  • Optional: PET-CT instead of Ultrasound, CXR and Bone CT

D2

* Grades of recommendation see here.

References

[McClain 2011] McClain K: Bone and Soft Tissue Involvement - Oral Presentation at the Annual Meeting of the Histiocyte Society, Vienna. 2011.

[Phillips et al 2009] Phillips M, Allen C, Gerson P, McClain K: Comparison of FDG-PET scans to conventional radiography and bone scans in management of Langerhans cell histiocytosis. Pediatric blood & cancer 2009, 52: 97 [PMID: 18951435]