Hodgkin lymphoma diagnosis and staging
To properly diagnose Hodgkin lymphoma, your doctor will start by taking your medical history and performing a physical examination, paying close attention to the lymph nodes and other parts of your body that might be affected, like the spleen and liver. Other diagnostic tests may follow, including:
This is the only way to be sure of the diagnosis. Your doctor will choose the best type of biopsy to do based on your situation:
Excisional or incisional biopsy. Your doctor cuts through the skin to remove the lymph node. If the whole lymph node is removed, it’s an excisional biopsy—if a small part of a larger tumor or node is removed, it’s an incisional biopsy.
Needle biopsy. A needle biopsy is less invasive than excisional or incisional biopsies. There are two main types:
- A 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.
- A core needle biopsy uses a larger needle to remove a slightly larger piece of tissue.
Immunohistochemistry. This lab test looks for certain proteins on cells, such as CD15 and CD30. These are found on the surface of the Reed-Sternberg cells in classic Hodgkin lymphoma (cHL).
Imaging tests. X-rays, sound waves, magnetic fields, or radioactive particles make pictures of the inside of the body. The imaging tests most commonly used:
- Chest X-ray.
- Computed tomography (CT) scan.
- Magnetic resonance imaging (MRI).
- Positron emission tomography (PET) scan.
- PET/CT scan. Some machines can do both a PET scan and a CT scan at the same time.
UCHealth follows the Lugano classification for staging Hodgkin lymphoma. It has 4 stages, labeled I, II, III, and IV.
For limited stage (I or II) HL that affects an organ outside of the lymph system, the letter E is added to the stage (for example, stage IE or IIE).
Stage I: Either of the following means that the HL is stage I:
- HL is found in only 1 lymph node area or lymphoid organ such as the thymus (I).
- The cancer is found only in 1 part of 1 organ outside the lymph system (IE).
Stage II: Either of the following means that the HL is stage II:
- HL is found in 2 or more lymph node areas on the same side of (above or below) the diaphragm, which is the thin muscle beneath the lungs that separates the chest and abdomen (II).
- The cancer extends locally from one lymph node area into a nearby organ (IIE).
Stage III: Either of the following means that the HL is stage III:
- HL is found in lymph node areas on both sides of (above and below) the diaphragm (III).
- HL is in lymph nodes above the diaphragm and in the spleen.
Stage IV: HL has spread widely into at least one organ outside of the lymph system, such as the liver, bone marrow, or lungs.
Source: American Cancer Society