Hodgkin's lymphoma diagnostic study of choice

The diagnostic study of choice for Hodgkin’s lymphoma is excisional lymph node biopsy. A bone marrow biopsy is an alternative to a lymph node biopsy.

• The diagnostic study of choice for Hodgkin’s lymphoma is excisional lymph node biopsy. An excisional biopsy is needed because it preserves the architecture of the lymph node and allows for precise determination of the type of lymphoma. Fine needle aspiration biopsy is insufficient. In addition to light microscopy evaluation of the excisional biopsy samples, the immunophenotypic analysis with immunohistochemistry helps to determine Hodgkin’s lymphoma subtypes and distinguish Hodgkin’s lymphoma from T cell rich large B cell lymphoma and anaplastic large cell lymphoma. The presence of Reed-Sternberg cells is diagnostic for classic Hodgkin’s lymphoma. The Reed-Sternberg cells of classic Hodgkin’s lymphoma particularly express CD15 and CD30 and do not present CD3 or CD45. Flow cytometry is an effective method in differentiating between classic Hodgkin’s lymphoma, nodular lymphocyte predominant Hodgkin’s lymphoma, and T cell rich large B cell lymphoma based upon the presence of specific T cell populations.^[1]

• A bone marrow biopsy can also be done to diagnose Hodgkin lymphoma if there is sufficient evidence of marrow involvement (i.e. presence of cytopenias). Hodgkin lymphoma cells originate in the bone marrow, which is the site of B cell production and maturation. A length of 2cm of the core biopsy is generally needed for diagnosis, which is in contrast to diagnostic requirements for leukemias. A bone marrow is not the diagnostic study of choice for Hodgkin lymphoma if a lymph node can be biopsied.

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