Diagnosis of Hodgkin Lymphoma
1. Lymph Node Biopsy
When HL is suspected, lymph nodes may be biopsied. A biopsy is a procedure in which a sample of tissue is taken from a lymph node or other parts of the body and sent to the laboratory for testing and evaluation. Depending on the location of the lymph node, the procedure may be very simple or slightly more involved, but in either case it is generally considered a minor surgery. Cases may be done in an outpatient surgical center or in a hospital operating room.

In an excisional biopsy, you are given an injection of local anesthetic so that you don't feel pain during the procedure. The skin above the suspicious lymph node(s) is opened with a small incision, and a single lymph node or a few of them are taken out. The cut is then stitched closed. The biopsy takes about 30 to 45 minutes, and you can return home soon after the procedure.

Alternatively, when the lymph nodes or other suspicious sites are deep inside the body, the biopsy procedure may involve scans of the body and imaging to guide a needle to the exact area of suspect tissue. The physician can than use the needle to access a sample, which is taken and sent to the pathologist for testing.

Fine needle aspiration is a procedure that is sometimes done, especially as a first step when there is a concern that a node in the neck could be involved with head and neck cancer. Fine needle aspiration, however, does not provide as good of a sample as an excisional biopsy for the initial diagnosis of HL.

Sometimes other sites such as the bone marrow are biopsied, but this is not usually a part of the routine evaluation for early HL.

2. Blood Tests
Blood tests such as the complete blood count or CBC involves an automated counter tallying up the blood cells of different types to determine whether your numbers fall in a normal or abnormal range. Findings are not specific to HL. Sometimes other markers from the blood may be used to add information to correlate with a prognosis. And screening for certain viral infections is also a part of the initial lab evaluation.

3. PET Scans and Imaging
PET scanning over recent years has become vital to the initial staging of Hodgkin lymphoma. PET scans can also help tell the difference between active tumors and fibrous areas that remain in the body after a person with HL has been treated. Guidelines from the National Comprehensive Cancer Network recommend PET/CT for initial staging and final response evaluation in patients with HL.

PET scans and CT scans are two different kinds of imaging that are often done together so that a good picture of the anatomy is rendered via the CT while the power of PET is harnessed to detect areas of disease that light up. A mass in the chest area, or mediastinum, is a very common finding in classical HL on PET/CT.