If an individual is suspected to have Hodgkin’s lymphoma, detailed investigations are required to establish the diagnosis and stage the disease, which in turn helps in selecting an appropriate treatment option.
Following are some commonly used investigations for Hodgkin’s lymphoma :
- Lymph Node Biopsy: This is the test which confirms the diagnosis of HL. Whole node excision biopsy is recommended.
Excisional biopsy: In this technique, the affected lymph node is removed surgically. The collected biopsy sample is then tested in a laboratory and can help in establishing the diagnosis of HL based on the presence of “Reed-Sternberg” or “Popcorn” cells in the biopsy sample and/or the characteristic of background cells. Further testing by immunohistochemistry helps in confirming the diagnosis.
- Imaging Tests: These tests help to detect the involvement of lymph nodes, liver, spleen, bones, etc by lymphoma and play an important role in defining the extent of disease. Alternatively, these tests are employed after treatment to evaluate the treatment efficacy and to detect any signs of disease progression/recurrence.
Positron emission tomography (PET) scan: This technique uses a radioactive substance (fluorodeoxyglucose [FDG], etc) that is given via intravenous injection prior to the procedure. Cancer cells absorb larger amounts of the radioactive substance than normal cells.
The areas of higher radioactivity indicate cancerous tissue on the PET scan. This technique is considered sensitive to stage HL and to assess response to treatment. It can also detect any bone lesion that may indicate bone involvement. It can also be combined with CT scan (PET/CT) to accurately diagnose the extent of disease in distant body parts.
The Deauville criteria are used to assess response to treatment during the treatment and at the end of the treatment based on the PET/CT assessed FDG uptake in the involved sites. The criteria use a 5-point scale to designate the FDG uptake in the involved sites relative to that of the mediastinum and the liver. Following table describe the different responses to treatment assessed according to the Deauville criteria based on PET/CT results:
|3||Uptake > mediastinum but </= liver|
|4||Uptake moderately higher than liver|
|5||Uptake markedly higher than liver and/or new lesions|
Computed tomography (CT) scan: In this technique, detailed cross-sectional images of body organs are generated using x-rays with or without contrast agents. It can be utilized for scanning neck, chest, abdomen and pelvis for the diagnosis of any abnormal lymph node or involvement of liver, spleen, or other extranodal structures. It can also be used to guide a biopsy needle to collect biopsy samples. Also, it can be used for determining the extent of disease and for planning the treatment in case radiation therapy is indicated for the treatment.
Magnetic resonance imaging (MRI) scan: This technique provides detailed images of internal body structures using radio waves, strong magnetic field, and gadolinium-based contrast material (which is used via intravenous injection to improve the clarity of the MRI images). It can be used when it is suspected that the disease has spread to the brain or spinal cord.
- Bone Marrow Biopsy: It is usually done in HL, except in very early stages without B symptoms and when PET-CT is suggestive of bone involvement. It helps to detect the involvement of bone by lymphoma and hence, stage the disease.
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In the next section, you will read about the staging of Hodgkin’s Lymphoma.