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.

Other techniques

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