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Having the correct diagnosis is important for getting the right treatment. Hodgkin lymphoma (HL) may be difficult to diagnosis. You may want to get a second medical opinion by an experienced 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.

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 HL. 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, a doctor who has special training in diagnosing blood diseases by studying cells under a microscope. The hematopathologist examines the samples using a microscope to look for cancer cells.

The lymph node biopsy's purpose is to confirm a diagnosis and

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


This laboratory test can detect specific cancer cells based on the types of antigens or proteins on the surface of the cells. Immunophenotyping is used to help diagnose specific types of leukemia and lymphoma.

Some of these tests may be repeated both during and after therapy to measure the effects of treatment.

Next Generation Sequencing and Liquid Biopsies

Next generation sequencing (NGS) tests can rapidly examine stretches of DNA. This technology can detect mutations and other genetic abnormalities in DNA extracted from blood or bone marrow samples. Due to the small number of Reed-Sternberg cells, performing genetic analysis from tumor samples in Hodgkin lymphoma can be difficult.

This method is currently under investigation in clinical trials, and it could become a complementary method to tissue biopsy in the near future. It could be particularly useful in cases where a tumor mass is difficult to biopsy or when there is very little tissue removed through biopsy.

Staging Tests

Once your hematologist-oncologist confirms a Hodgkin lymphoma diagnosis, he or she orders more tests to stage your disease. Staging identifies the extent of your disease and where it's located in your body.

Staging tests include:

  • Imaging tests
  • Blood tests
  • Bone marrow tests

Some of these tests may be repeated, both during and after therapy, to measure the response to treatment.

Imaging Tests

Imaging tests help the doctor evaluate:

  • The location and distribution of enlarged lymph nodes
  • Whether organs other than lymph nodes are involved
  • Whether there are very large masses of tumors in one site or another

Imaging tests may include:

  • Chest X-ray
  • CT (computed tomography) scan of the neck, chest, pelvis and abdomen (stomach area)
  • PET-CT scan (positron emission tomography-computed tomography) scan, a combination PET and CT scan, of the entire body with a radioactive tracer
    • This is also referred to as a "FDG-PET scan" (fluorodeoxyglucose [FDG] positron emission tomography [PET]). 
  • MRI (magnetic resonance imaging), in select cases  

Blood Tests

Blood tests may include 

  • Complete blood count (CBC). This test measures the number of blood cells in a sample, including red blood cells, white blood cells, and platelets. A low level of red blood cells, white blood cells or platelets may indicate that the lymphoma is present in the bone marrow and/or blood.
  • Comprehensive metabolic panel (CMP). This test measures 14 different substances in the blood. It can detect a range of abnormalities in blood sugar and nutrient balance, and also evaluate liver and kidney health. 
  • Erythrocyte sedimentation rate (ESR). This test is done to determine the rate at which the red blood cells settle to the bottom of a tube. The “sedimentation” rate is a measure of how much inflammation is in the body. Inflammation is the body’s attempt to heal itself. The ESR may be higher than normal for some people with HL.
  • Lactate dehydrogenase (LDH). This is a protein normally present in most cells that is released into the blood when a cell is damaged. A high level of LDH in the blood is a sign of cell damage. The level of LDH can be higher than normal in people with HL when the cancer is more active and doing more damage to cells.
  • Liver and kidney function tests. These tests can help determine if cancer has affected these organs. 
  • Human immunodeficiency virus (HIV) and hepatitis B testing. Tests for both HIV and hepatitis B should be part of the pretreatment workup for patients with HL, since these diseases can affect cancer treatment. 

    Heart and Lung Tests

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

    Pregnancy Test

    Some cancer treatments can harm an unborn baby, so a pregnancy test is recommended before beginning treatment. Treatment options may depend on the results. 

    Bone Marrow Tests

    Some patients who have been diagnosed with HL may need to undergo a bone marrow aspiration and biopsy. These tests are not typically used to diagnose HL, but they may be done after diagnosis to see if there are lymphoma cells in the bone marrow. The doctor will decide if these procedures are necessary. Also, the need for a bone marrow biopsy may be eliminated by the use of a PET scan to assess the disease.

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