Hodgkin lymphoma diagnosis

Having the correct diagnosis is important for getting the right treatment. Hodgkin lymphoma may be difficult to diagnose, so you may want to get a second medical opinion from a hematopathologist before you begin treatment. A hematopathologist is a specialist who studies blood and bone marrow cells and other tissues to help diagnose diseases of the blood, bone marrow, and lymph system.  

The information on this page covers how Hodgkin lymphoma is diagnosed in adults. Visit childhood Hodgkin lymphoma to learn about signs and symptoms, diagnosis, and treatment information for children with Hodgkin lymphoma. 

Tests your doctor may use to diagnose and stage Hodgkin lymphoma 

Your doctor may use the following tests to diagnose Hodgkin lymphoma:

Patient evaluation  

Your doctor will take a comprehensive medical history and ask questions regarding your symptoms. A physical examination will include assessment of all accessible lymph node groups (neck, underarms, and groin) as well as the size of palpable organs such as the spleen and liver. 

Lymph node biopsy  

A biopsy of an enlarged lymph node is needed to diagnose Hodgkin lymphoma. The preferred and most common type of biopsy is called an “excisional biopsy,” in which the whole lymph node is typically removed (excised). If the lymph node is just under the skin, the biopsy procedure is usually simple and can sometimes be done with a numbing medication (local anesthetic). If the lymph node is inside the chest or abdomen (stomach area), you may be sedated or receive general anesthesia.  

The biopsy samples will be sent to a hematopathologist, who will examine the samples with a microscope to look for cancer cells. The lymph node biopsy's purpose is to confirm a diagnosis and identify your Hodgkin lymphoma subtype so that a treatment plan can be developed. 

It is important that a specialist with experience in diagnosing Hodgkin lymphoma analyzes the biopsy tissue. Pathology slides may be sent to a specialty lab for confirmation of diagnosis.  

View the interactive 3D model to help you visualize and better understand the procedure. Click or tap the "Interact in 3D" button to begin. 

View all 3D models. 

Blood tests 

Blood tests are used to check red blood cell, white blood cell and platelet counts; blood tests also check for other signs of disease.  

Learn more about blood tests. 

Bone marrow tests 

Bone marrow tests are done to look for HL cells in the bone marrow. Bone marrow aspiration and bone marrow biopsy are two tests that may be done in the doctor’s office or in a hospital. These tests are often done at the same time. 

• A bone marrow aspiration removes a certain amount of fluid from the bone marrow.
• A bone marrow biopsy is done with a slightly larger needle and removes a solid portion of the bone.  

Some patients are awake for this procedure. Medication may be used to numb the body area where the procedure will take place. This is usually the area in the back of the patient’s pelvic bone. Some patients are given a drug and sedated (asleep) for the procedure.  

Blood and bone marrow test may be done both during and after treatment. These tests are repeated to see if treatment is working.  

Learn more about bone marrow tests. 

View the interactive 3D model to help you visualize and better understand the procedure. Click or tap the "Interact in 3D" button to begin.

View all 3D models. 

Imaging tests 

Imaging tests help the doctor to see if there are lymphoma masses in the lymph nodes, liver, spleen or lungs. 

Imaging tests may include: 

• Chest X-ray
• PET-CT (positron emission tomography-computed tomography) scan, a combination PET and CT scan, of the entire body with a radioactive trace
• MRI (magnetic resonance imaging), in select cases   

Learn more about lab and imaging tests. 

Heart and lung tests  

Some Hodgkin lymphoma treatments may weaken or damage the heart and lungs. The healthcare team may decide to test how well these organs work in order to plan for the appropriate treatment. 

Pregnancy test  

In addition to diagnostic tests, Some cancer treatments can harm an unborn baby, so a pregnancy test is recommended before undergoing treatment. Treatment options may depend on the results.  

How doctors determine the stage and category of hodgkin lymphoma
Once your hematologist-oncologist confirms a Hodgkin lymphoma diagnosis, they will order more tests to stage your disease. Staging identifies the extent of your disease and where it's located in your body. Some of these tests may be repeated, both during and after therapy, to measure the response to treatment. 

Doctors use physical examinations, imaging tests, blood tests, and sometimes bone marrow tests to determine the extent of the disease.  This determination is called "staging."  Staging provides important information for treatment planning. Stages, categories, and their definitions are included in the illustration below.

Prognostic factors 

“Prognosis” is the likely outcome of a disease along with the chance of recovery or recurrence. Hodgkin lymphoma cases are generally classified into the three subgroups: 

• Early-stage favorable: Stage I to II with no unfavorable risk factors
• Early-stage unfavorable: Stage I to II with unfavorable risk factors
• Advanced stage: Stage III to IV 

Diagnosing Hodgkin lymphoma subtypes

It is important to know your subtype because it plays a large part in determining the type of treatment you will receive. 

Classical Hodgkin Lymphoma (cHL): About 95 percent of patients have this type, which has been further divided into these categories: 

• Nodular sclerosis
• Mixed cellularity
• Lymphocyte-rich
• Lymphocyte-depleted  

Nodular Lymphocyte-Predominant B-cell Lymphoma (NLPBL), formerly called Nodular Lymphocyte-Predominant Hodgkin Lymphoma: About 5 percent of cases have this type. (NLPBL is no longer considered an Hodgkin lymphoma subtype, but a separate disease.) 

Nodular lymphocyte-predominant B-cell lymphoma (NLPBL) 

Nodular lymphocyte-predominant B–cell lymphoma (NLPBL) is characterized by the presence of lymphocyte-predominant cells, sometimes termed “popcorn cells,” which are a variant of RS cells.   

The following are some characteristics of NLPHL: 

• Most common in 30- to 50-year-old age group
• More common in males
• Slow growing and can relapse many years later
• Highly curable
• Small risk of transformation to aggressive non-Hodgkin lymphoma (7 percent of cases)