Tests for Hodgkin Lymphoma
Most people with Hodgkin lymphoma 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 lymphoma, exams and tests will be done to find out for sure and, if so, to determine the exact type.
Medical history and physical exam
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 examine you, 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 lymphoma might be causing the symptoms, he or she might recommend a biopsy of a swollen lymph node.
Because swollen lymph nodes are more likely to be caused by something other than Hodgkin lymphoma, such as an infection, 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 if they continue to grow, a lymph node (or a small piece of a node) is removed to be looked at under a microscope and for other lab tests. This procedure, called a biopsy, is needed to be sure of the diagnosis. If it is Hodgkin lymphoma, the biopsy sample can also show 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 entire lymph node is removed, it is an excisional biopsy.
- If a small part of a larger tumor or node is removed, it is 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 lymphoma and to tell the exact type.
Needle biopsy: Needle biopsies are less invasive than excisional or incisional biopsies, but the drawback is that they might not remove enough of a sample to diagnose Hodgkin lymphoma (or to determine which type it is). There are 2 main types of needle biopsies:
- A fine needle aspiration (FNA) biopsy uses a very thin, hollow needle attached to a syringe to withdraw (aspirate) a small amount of fluid and tiny bits of tissue.
- A core needle biopsy uses a larger needle to remove a slightly larger piece of tissue.
To biopsy an enlarged node just under the skin, the doctor can aim the needle while feeling the node. If a node or tumor is deep inside the body, the doctor can guide the needle using a computed tomography (CT) scan or ultrasound (see below).
Most doctors do not use needle biopsies (especially FNA biopsies) to diagnose Hodgkin lymphoma. 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 lymphoma, even after a needle biopsy has been done.
If Hodgkin lymphoma has already been diagnosed, needle biopsies are sometimes used to check abnormal areas in other parts of the body that might be from the lymphoma spreading or coming back after treatment.
Bone marrow aspiration and biopsy: These tests are not used to diagnose Hodgkin lymphoma, but they may be done after the diagnosis is made to see if the lymphoma is in the bone marrow. The bone marrow aspiration and biopsy are usually done at the same time. The samples are taken from the back of the pelvic (hip) bone, although sometimes they may be taken from other bones.
In bone marrow aspiration, you lie on a table (either on your side or on your belly). After cleaning the skin over the hip, the doctor numbs the area and the surface of the bone by injecting a local anesthetic, which may cause a brief stinging or burning sensation. A thin, hollow needle is then inserted into the bone, and a syringe is used to suck out a small amount of liquid bone marrow. Even with the anesthetic, most patients have some brief pain when the marrow is removed.
A bone marrow biopsy is usually done just after the aspiration. A small piece of bone and marrow is removed with a slightly larger needle that is pushed down into the bone. The biopsy may also cause some brief pain.
Most children having a bone marrow aspiration and biopsy either receive medicine to make them drowsy or have general anesthesia so they are asleep.
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 will look for Hodgkin lymphoma cells (called Reed-Sternberg cells). 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 lymphoma (and what type it is), but sometimes further lab tests are needed.
Immunohistochemistry: This lab test looks for certain proteins on cells, such as CD15 and CD30, which are found on the surface of the Reed-Sternberg cells in classic Hodgkin lymphoma. Tests for other proteins may point to nodular lymphocyte predominant Hodgkin lymphoma, to non-Hodgkin lymphoma (rather than Hodgkin lymphoma), or to other diseases entirely.
Imaging tests use x-rays, sound waves, magnetic fields, or radioactive particles to make pictures of the inside of the body. Imaging tests may be done for a number of reasons, including:
- To look for possible causes of certain symptoms, such as enlarged lymph nodes in the chest
- To help determine the stage (extent) of Hodgkin lymphoma
- To help show if treatment is working
- To look for possible signs of cancer coming back after treatment
Hodgkin lymphoma often enlarges lymph nodes in the chest, which can usually be seen on a chest x-ray.
Computed tomography (CT) scan
A CT scan combines many x-rays to make detailed cross-sectional images of your body. This scan can help tell if any lymph nodes or organs in your body are enlarged. CT scans are useful for looking for Hodgkin lymphoma in the neck, chest, abdomen, and pelvis.
CT-guided needle biopsy: A CT scan can also be used to guide a biopsy needle into a suspicious area. For this procedure, a person lies on the CT scanning table while the doctor moves a biopsy needle through the skin and toward the area. CT scans are repeated until the needle is in the right place. A biopsy sample is then removed and sent to the lab to be looked at under a microscope.
Magnetic resonance imaging (MRI)
Like CT scans, MRIs show detailed images of soft tissues in the body. But MRIs use radio waves and strong magnets instead of x-rays. This test is rarely used in Hodgkin lymphoma, but if the doctor is concerned about spread to the spinal cord or brain, MRI is very useful for looking at these areas.
Positron emission tomography (PET) scan
For a PET scan, you are injected with a slightly radioactive form of sugar, which collects especially in cancer cells. A special camera is then used to create a picture of areas of radioactivity in the body. The picture is not detailed like a CT or MRI scan, but it can provide helpful information about your whole body.
PET scans can be used for many reasons in a person with Hodgkin lymphoma:
- They can help show if an enlarged lymph node contains Hodgkin lymphoma.
- They can help spot small areas in the body that might be lymphoma, even if the area looks normal on a CT scan.
- They can help tell if the lymphoma is responding to treatment. Some doctors will repeat the PET scan after a few courses of chemotherapy. If it is working, the lymph nodes will no longer take up the radioactive sugar.
- They can be used after treatment to help decide if an enlarged lymph node still has cancer or if it is just scar tissue.
PET/CT scan: Some machines can do both a PET scan and a CT scan at the same time. This lets the doctor compare areas of higher radioactivity on the PET scan with the more detailed appearance of that area on the CT scan. PET/CT scans often can help pinpoint the areas of lymphoma better than a CT scan alone.
This test is not usually done unless a person is having bone pain or has lab test results that suggest the lymphoma might have reached the bones.
For this test, a radioactive substance (technetium) is injected into a vein. It travels to damaged areas of bone, and a special camera can then detect the radioactivity. Hodgkin lymphoma sometimes causes bone damage, which may be picked up on a bone scan. But bone scans can’t show the difference between cancers and non-cancerous problems, so further tests might be needed.
Blood tests aren’t used to diagnose Hodgkin lymphoma, but they can help your doctor get a sense of how advanced it is and how well you might tolerate certain treatments.
The complete blood count (CBC) is a test that measures the levels of different cells in the blood. People with Hodgkin lymphoma can sometimes have abnormal blood counts. For example, if the lymphoma invades the bone marrow (where new blood cells are made) a person might have anemia (not enough red blood cells). A high white blood cell count is another possible sign of Hodgkin lymphoma, although it can also be caused by infection.
A test called an erythrocyte sedimentation rate (ESR) can help measure how much inflammation is in the body. It can be elevated in some people with Hodgkin lymphoma.
Blood tests might also be done to check liver and kidney function and to look for signs that the cancer might have reached the bones.
Your doctor might also suggest other blood tests to look for signs of certain infections:
- HIV test: especially if you have abnormal symptoms that might be related to HIV infection
- Hepatitis B virus test: if your doctor plans on using the drug rituximab (Rituxan) in your treatment, which could cause problems if you have this infection
Tests of heart and lung function
These tests might be done if certain chemotherapy drugs that could affect the heart or the lungs are going to be used.
- An echocardiogram (an ultrasound of the heart) or a MUGA scan can be used to check heart function.
- Lung (pulmonary) function tests (PFTs) can be used to see how well the lungs are working. For these tests, you breathe into a tube connected to a machine.
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National Cancer Institute. Physician Data Query (PDQ). Adult Hodgkin Lymphoma Treatment. 2016. Accessed at www.cancer.gov/types/lymphoma/hp/adult-hodgkin-treatment-pdq on April 20, 2016.
National Comprehensive Cancer Network (NCCN). Practice Guidelines in Oncology: Hodgkin Lymphoma. Version 2.2016. Accessed at www.nccn.org/professionals/physician_gls/pdf/hodgkins.pdf on April 20, 2016.
Younes A, Carbone A, Johnson P, Dabaja B, Ansell S, Kuruvilla J. Chapter 102: Hodgkin’s lymphoma. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2015.
Last Medical Review: February 10, 2017 Last Revised: March 28, 2017