A biopsy is the only way for your doctors to know for sure if you have Hodgkin disease. For a biopsy, the doctor removes a sample of the tumor. The sample is sent to a lab, where a pathologist checks it under a microscope for cancer cells. Several types of biopsies can be done to look for Hodgkin disease.
Your doctor may choose this type of biopsy if swollen lymph nodes can be felt in your neck or the armpit. The doctor uses a very thin, hollow needle (for an FNA) or a slightly larger needle (for a core needle biopsy) to take a small sample of tissue from the tumor. For tumors deeper in the body, ultrasound or CT scans may be used to help the doctor guide the needle into place.
In some cases, this thin needle doesn’t remove enough tissue for the pathologist to see cancerous cells. Or the sample may also be too small to tell the type of lymphoma. Because of this, most doctors prefer not to use a needle biopsy to try to diagnose Hodgkin disease. It may be helpful, however, if Hodgkin disease has already been diagnosed and the doctor is trying to determine if swelling in another part of the body might be due to the spread of the lymphoma.
This is usually the preferred type of biopsy if your doctor suspects you may have Hodgkin disease. In an excisional biopsy, a surgeon takes out a whole lymph node. This type of biopsy almost always gives the pathologist enough tissue to make a complete diagnosis. In an incisional biopsy, only part of the tumor is taken out. This form of biopsy can be useful to tell whether additional sites or recurrence (a return of the disease) are present.
Because Hodgkin disease can spread to the bone marrow, some people who have already been diagnosed with the condition will have a sample of the bone marrow (the soft, inner part of certain bones) analyzed for any signs of the disease. For this procedure, the doctor uses a needle to take out small amounts of your liquid bone marrow, called the aspirate, as well as a small piece of the bone called the biopsy. The tissue is usually taken from the bone in the back of your hips.