Hodgkin Lymphoma: Tests and Diagnosis

What tests are used to diagnose Hodgkin lymphoma?

Diagnosis of Hodgkin lymphoma (also called Hodgkin’s disease) requires a biopsy of one of the affected lymph nodes. A biopsy is a small sample of tissue obtained by a surgeon.

Biopsies are minor surgical procedures that are usually done in the operating room while the child is asleep so that they don’t experience any pain. Usually, patients are able to go home the same day that the biopsy is done and don’t need to stay in the hospital.

The tissue from the biopsy is looked at under the microscope by a pathologist, who makes the diagnosis. Usually, it takes a day or two to gather all the information needed to make a diagnosis once the biopsy has been done, although in some cases it may take longer.

How do doctors know if the lymphoma has spread?

Once a diagnosis is made, the next important step is to figure out how widespread the lymphoma is within the body. This process is called tumor staging and involves a series of imaging tests to look for disease throughout the body, a bone marrow test and blood tests.

A chest X-ray is used to check for any enlarged lymph nodes in the chest. A CT scan (or CAT scan) gives doctors even more detailed pictures of the inside of the neck, chest, abdomen and pelvis to look for any other sites of disease. A PET scan is used to look for any areas in the body that are using up sugar faster than usual, indicating that they have increased metabolic activity. One characteristic of lymphoma cells is that they have increased metabolic activity, so PET scans are a sensitive way to find any areas in the body where the lymphoma may be hiding.

Because the lymphoma cells can also hide in the bone marrow, an additional test often done as part of the staging process is a bone marrow aspirate and biopsy. A small amount (around a teaspoon) of bone marrow is drawn out of the back hipbones through a needle. This procedure is painful, so it is almost always done while the patient is asleep in the operating room. It may be done at the same time as the biopsy of the lymph node if your doctor suspects the chance for lymphoma to be high.

In addition, basic blood tests will be done to check the function of the bone marrow, kidneys and liver and to check for signs of inflammation.

What to expect from testing for Hodgkin lymphoma

All of these scans and tests can be done as an outpatient and don’t require a child to stay in the hospital, but it takes a few days to get them done. Treatment isn’t started until the tests are complete so that your child’s doctors at Children’s Hospital Colorado can select the best treatment course.

How is Hodgkin lymphoma diagnosed?

With all of the information collected from testing, your child’s doctors will assign a stage (I to IV) that describes how far the cancer has spread. Staging is important, because it helps doctors plan the most effective treatment.

  • Stage I means that the lymphoma only involves one lymph node area.
  • Stage II means that the lymphoma involves more than one lymph node area, but all of the disease is either above or below the diaphragm, which is the thin muscle that helps us to breathe. 
  • Stage III means that the lymphoma involves areas above the diaphragm and below the diaphragm. 
  • Stage IV means that the lymphoma involves organs outside of the lymph nodes and spleen, such as the bone marrow, bones, liver and lungs. If there are B symptoms like fever and night sweats, the stage is followed by a “B” (for example, stage II B). If there are no B symptoms, then the stage is followed by an “A.” 

Why choose Children’s Hospital Colorado for your child’s testing?

Whenever possible, we prefer that all tests for Hodgkin lymphoma be done at Children’s Colorado. This helps ensure that we are getting the best, most accurate information and that everything is done as kid-friendly as possible, with pediatric surgeons, radiologists, anesthesiologists and phlebotomists who are experienced in working with children and their families.

If these tests are done elsewhere, however, we will still be able to gather the information and use it to provide the best care possible.