Hodgkin's Disease - Diagnosis

Other Advanced Imaging Techniques. Other newer advanced imaging techniques, including positron emission tomography (PET) and gallium-67 scintigraphy, are proving to be very helpful. Gallium scintigraphy has also been proven to detect the presence of HD, relapse, progression, and helps doctors to predict outcome. A specific PET scan technique called FDG-PET may be even more useful, because it can detect more disease sites both above and below the diaphragm. These imaging techniques can be used for staging the disease, often reducing the need for invasive procedures, which are required for examining areas undetectable using standard imaging techniques. Magnetic resonance imaging (MRI) has been used but has not yet proven to be very useful beyond the evaluation of the chest wall.

Click the icon to see an image of a MRI machine.

Lymphangiography. Lymphangiography is an x-ray of the lymph glands and vessels after an injection of a dye. It might provide additional information on lower parts of the body, but it is generally not performed routinely. By itself, lymphangiography misses cancer in 20% of cases. It may be used after a diagnosis of stage I or II Hodgkin's disease to pinpoint the location of lymph nodes that are scheduled to be treated. There is a small risk that the dye will affect the lungs, so this test should not be used in patients with severe lung disease. The test is usually not necessary in patients who are receiving multidrug chemotherapy. It is also not usually performed on children.

Click the icon to see an image of a lymphangiogram.

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Biopsy

A biopsy of the suspicious lymph node is the most definitive way to diagnose Hodgkin's disease. A biopsy has risks, and should only be performed by a qualified and experienced doctor. Sometimes a doctor may choose to wait and observe the involved lymph nodes, which will usually regress on their own if a temporary infection is causing the enlargement. However, some lymphomas may regress and appear to be benign, only to reappear at a later time.

The Procedure. During a biopsy, the doctor usually removes the node and checks the surrounding areas. The tissue in the node is then examined for signs of infection and blood cell or other abnormalities. Biopsies of bone marrow may also be performed in patients with existing Hodgkin's disease if the doctor suspects that it may have spread to the marrow.

Laparotomy and Laparoscopy

Laparotomy and laparoscopy are abdominal surgeries that have been used to examine internal organs and stage the disease in patients who were candidates for radiation. The goal was to determine whether the disease had spread or not. They play a more limited role in HD management now than previously, since many patients receive a combination of chemotherapy, (which fights cancer throughout the body), and radiation for local disease, making this procedure unnecessary.