Tests for Hodgkin Lymphoma

This is the preferred and most common type of biopsy for an enlarged lymph node. For this procedure, the doctor cuts through your skin to remove the lymph node.

• Excisional biopsy: The whole lymph node is removed.
• Incisional biopsy: A small part of a larger tumor or node is removed.

If the node is just under your skin, the biopsy can sometimes be done with numbing medicine, called local anesthesia. If the node is inside your chest or abdomen (belly), you'll be sedated or given general anesthesia to put you in a deep sleep.

This type of biopsy almost always provides enough tissue to make a diagnosis of Hodgkin lymphoma and find out the exact type.

A needle biopsy is less invasive than excisional or incisional biopsies because there's no cut in the skin. However, the drawback is that it might not get enough tissue to diagnose Hodgkin lymphoma or find out which type it is.

There are 2 main types of needle biopsies:

• Fine needle aspiration (FNA) biopsy uses a very thin, hollow needle attached to a syringe to take out (aspirate) a small amount of fluid and tiny bits of tissue. This type of biopsy doesn’t usually provide enough tissue to make a diagnosis of lymphoma.  
• Core needle biopsy uses a larger needle to remove a larger piece of tissue.

To biopsy an enlarged node just under your skin, the doctor can aim the needle while feeling the node. If a node or tumor is deep inside your body, a CT scan or ultrasound can be used to guide the needle.

If Hodgkin lymphoma has already been diagnosed, needle biopsies are sometimes used to check changes, like swollen nodes, in other parts of the body to see if the lymphoma has spread or come back after treatment.

These tests aren’t used to diagnose Hodgkin lymphoma, but they may be done after a diagnosis to see if the lymphoma is in your bone marrow. They are generally done at the same time. The samples are usually taken from the back of your pelvic bone (hip), but sometimes they are taken from other bones.

Bone marrow aspiration

For this procedure you lie on a table, either on your side or your belly. After cleaning the skin over your hip, the doctor numbs the skin and the surface of the bone by injecting a local anesthetic (numbing drug). This may cause a brief stinging or burning feeling.

The doctor pushes a thin, hollow needle into the bone and uses a syringe to suck out a small amount of liquid bone marrow. Even with the anesthetic, most people have some brief discomfort when the marrow is pulled out.

Bone marrow biopsy

A bone marrow biopsy is usually done just after the aspiration. A small piece or core of bone and marrow is removed with a slightly larger needle pushed into the bone. The biopsy may also cause some brief discomfort.

For children

Most children having a bone marrow aspiration and biopsy are either given medicine to make them drowsy or general anesthesia to put them in a deep sleep.

This lab test looks for certain proteins on cells, such as CD15 and CD30. These proteins are found on the surface of the Reed-Sternberg cells in classic Hodgkin lymphoma (cHL). Tests for other proteins may point to nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL), non-Hodgkin lymphoma, or other diseases.

You can learn more about these in Biopsy and Cytology Tests.

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 when looking for HL in the neck, chest, abdomen (belly), 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, you lie on the CT scanning table while the doctor moves a biopsy needle through your skin and toward the area.

CT scans are repeated until the needle is in the right place. The doctor then removes a biopsy sample and sends it to the lab to be looked at under a microscope.

This test is rarely used in HL, but if the doctor is concerned about lymphoma spread to the spinal cord or brain, MRI is useful for looking at these areas. MRIs use radio waves and strong magnets instead of x-rays.

Researchers are also trying to find out if MRI scans might work as well as PET/CT scans in children and teens with Hodgkin lymphoma. If so, this would mean less radiation exposure and fewer resulting long-term side effects in young people.

For a PET scan, a small amount of radioactive sugar is injected into your bloodstream. The sugar tends to collect in cells that are more active, such as some cancer cells. A special camera then takes pictures showing where the sugar has gathered in your body.

A PET/CT scan combines a PET scan with a CT scan in one test. This lets doctors see the areas of higher activity on the PET scan and the detailed anatomy shown by the CT scan at the same time. This combination can make it easier to see where lymphoma might be.

Doctors often use PET/CT scans to help stage cancer, meaning to find out whether it has spread. These scans can show most parts of the body, although they are not typically used to look at the brain or spinal cord.

This test measures the levels of different cells in your blood. People with Hodgkin lymphoma sometimes have abnormal blood counts.

For example:

• If the lymphoma causes your bone marrow to no longer make normal amounts of red blood cells, you may have anemia.
• A high white blood cell count is another possible sign of Hodgkin lymphoma, although it can also be caused by infection.

This test helps measure how much inflammation is in your body. Inflammation 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 your bones. Some people may need to take a pregnancy test before certain tests or treatments.

Your cancer care team might also suggest other blood tests to look for signs of certain infections:

• HIV test: This may be done if you have abnormal symptoms that might be related to HIV infection.
• Hepatitis B and C virus tests: Certain chemo drugs could cause problems if you have these infections.