Imaging pitfalls in pediatric, adolescent, and young adult Hodgkin lymphoma: a SEARCH for CAYAHL initiative to bridge multidisciplinary patient care

Pediatric Hodgkin lymphoma (pHL) is a highly curable malignancy in children, adolescents, and young adults, and current treatment strategies aim to minimize adverse late effects. Many patients are enrolled in clinical trials with centralized review for both initial and interim staging. Although academic guidelines provide a structured framework for image interpretation, real-world clinical scenarios sometimes present imaging pitfalls that require nuanced judgment. Morphologic and metabolic imaging pitfalls refer to misinterpretation of findings that occur during staging, disease evaluation, or post-treatment surveillance. In pHL, such pitfalls may result from suboptimal imaging conditions, concurrent inflammatory, infectious, or other findings. These findings do not indicate neoplastic disease but rather are manifestations of other processes specific to each tissue or organ. This Staging, Evaluation and Response Criteria Harmonization for Childhood, Adolescent, and Young Adult Hodgkin Lymphoma (SEARCH for CAYAHL) initiative represents a transatlantic collaboration among multidisciplinary professionals, aiming to disseminate the insights gained from decades of centralized review experience in North American and European clinical trials. This paper aims to optimize patient care by integrating imaging and clinical expertise in disease staging and surveillance. Although not intended as a comprehensive staging guide, it highlights recurrent imaging pitfalls that may lead to incorrect staging or response assessment. By encouraging interdisciplinary exchange, this work seeks to complement existing literature and serve as a troubleshooting guide for situations where clinical realities diverge from academic paradigms.