How is Hodgkin disease diagnosed?
Most people with Hodgkin disease see their doctor because they have certain symptoms, or because they just don’t feel well and go in for a checkup.
If a person has signs or symptoms that suggest Hodgkin disease, exams and tests are done to find out for sure and, if so, to determine the exact type.
Medical history and physical exam
If symptoms suggest you or your child might have Hodgkin disease, your doctor will want to get a thorough medical history, including information about symptoms, possible risk factors, family history, and other medical conditions.
Next, the doctor will do a physical exam, paying special attention to the lymph nodes and other areas of the body that might be affected, including the spleen and liver. Because infections are the most common cause of enlarged lymph nodes, especially in children, the doctor will look for an infection in the part of the body near any swollen lymph nodes.
The doctor also might order blood tests to look for signs of infection or other problems. If the doctor suspects that Hodgkin disease might be causing the symptoms, he or she will recommend a biopsy of the area.
Many of the symptoms of Hodgkin disease are actually more likely to be caused by something else. For example, enlarged lymph nodes are more often caused by infections than by Hodgkin disease. Because of this, doctors often wait a few weeks to see if they shrink on their own as the infection goes away. Antibiotics may also be prescribed to see if they cause the nodes to shrink.
If the nodes don’t shrink or continue to grow, a lymph node (or a small piece of a node) is removed to be looked at under the microscope and for other lab tests. This procedure, called a biopsy, is needed to be sure of the diagnosis. If it is Hodgkin disease, the biopsy can also tell what type it is.
Types of biopsies
There are different types of biopsies. Doctors choose the best one based on the situation.
Excisional or incisional biopsy: This is the preferred and most common type of biopsy for an enlarged lymph node. The doctor cuts through the skin to remove the lymph node. If the doctor removes the entire lymph node, it is called an excisional biopsy. If a small part of a larger tumor or node is removed, it is called an incisional biopsy.
If the node is just under the skin, this is a fairly simple operation that can sometimes be done with numbing medicine (local anesthesia). But if the node is inside the chest or abdomen, the patient is sedated or given general anesthesia (where he or she is in a deep sleep). This type of biopsy almost always provides enough of a tissue sample to make a diagnosis of Hodgkin disease and to tell the exact type.
Fine needle aspiration (FNA) or core needle biopsy: In an FNA biopsy, the doctor uses a very thin, hollow needle attached to a syringe to withdraw (aspirate) a small amount of fluid and tiny bits of tissue from a lymph node or an organ in the body. For a core needle biopsy, the doctor uses a larger needle to remove a slightly larger piece of tissue.
If the enlarged node is just under the skin, the doctor can aim the needle while feeling the node. If a tumor is deep inside the body, the doctor can guide the needle using a computed tomography (CT) scan or ultrasound (see discussion of imaging tests in “How is Hodgkin disease staged?”).
A needle biopsy does not require an incision, but in many cases it might not remove enough of a sample to diagnose Hodgkin disease (or to determine which type it is). Most doctors do not use needle biopsies (especially FNA biopsies) to diagnose Hodgkin disease. But if the doctor suspects that your lymph node swelling is caused by an infection or by the spread of cancer from another organ (such as the breast, lungs, or thyroid), a needle biopsy might be the first type of biopsy done. An excisional biopsy may still be needed to diagnose Hodgkin disease, even after a needle biopsy has been done.
If Hodgkin disease has already been diagnosed, needle biopsies are sometimes used to check areas in other parts of the body that might be Hodgkin disease spreading or coming back after treatment.
Bone marrow aspiration and biopsy: These tests are not used to diagnose Hodgkin disease, but they may be done after the diagnosis is made to see if Hodgkin disease is in the bone marrow. They are described in more detail in “How is Hodgkin disease staged?”
Lab tests of biopsy samples
All biopsy samples are looked at under a microscope by a pathologist (a doctor specially trained to recognize cancer cells), who looks at the size and shape of the cells and determines if any of them are Reed-Sternberg cells. The pathologist also looks at how the cells are arranged, which could point to the type of Hodgkin disease.
Because diagnosing Hodgkin disease can be tricky, it helps if the pathologist specializes in diseases of the blood. Sometimes the first biopsy does not give a definite answer and more biopsies are needed.
Looking at the samples under the microscope is often enough to diagnose Hodgkin disease (and what type it is), but sometimes further lab tests are needed.
Immunohistochemistry: In this test, a part of the biopsy sample is treated with special antibodies (man-made versions of immune system proteins) that will attach only to certain molecules on the surface of cells. These antibodies cause color changes that can be seen under a microscope. This test can show certain proteins, such as CD15 and CD30, on the surface of the Reed-Sternberg cells. These are typically found in classic Hodgkin disease. Tests for other proteins may point to nodular lymphocyte predominant Hodgkin disease, to non-Hodgkin lymphoma rather than Hodgkin disease, or to other diseases entirely.
Last Medical Review: 07/10/2014
Last Revised: 02/09/2016