Clinical evaluation

The most important step in evaluating a patient with possible Hodgkin lymphoma is examination of an adequate biopsy by an experienced hematopathologist. Usually an excisional biopsy is best, but in some situations a generous cutting needle biopsy can be adequate. A careful history and physical remains a key part of the evaluation of a patient with Hodgkin lymphoma and can direct further evaluation. In general the most useful imaging study is the PET-CT scan. The purpose of the initial evaluation is to identify those patients with local disease for which treatment might be different, those with more widespread disease, and those with an unfavorable prognosis. The initial treatment decision is usually based on the assignment of the patient to one of these groups. It is increasingly frequent to use an interim re-evaluation of the patient after the first two cycles of therapy. In some cases the treatment might be modified based on these results. The goal of therapy is to have the patient in complete remission, usually as documented by a PET-CT scan, at the completion of the planned course of therapy. In the absence of clinical signs of recurrent lymphoma, no further imaging studies would need to be done after documentation of a complete remission.