lymphocytes. ■ The pathologist examines the slides under a microscope to look for the visible color change that happens when the antibodies attach to the antigens. ■ The pathologist identifies and counts the number of cells that are highlighted by color (meaning that they have the antigen on their surface or inside the cell) with each of the different antibodies. Flow Cytometry ■ Cells from the biopsy sample are placed in a liquid solution and treated with sets of antibodies that recognize antigens found in different types of lymphoma cells. ■ The cell-antibody mixture is injected into an instrument called a flow cytometer. This machine uses laser beams to detect the different colors of light the cells emit from the antibodies attached to them. This information is measured and analyzed by a computer and interpreted by a hematopathologist or another specialist. ■ This approach to immunophenotyping is not used in the diagnosis of HL as frequently as it is for other diseases. Learning the Basics 30 Part 1 It is important for patients to discuss the interpretation of diagnostic tests with their doctor. Here is a list of some important considerations when interpreting diagnostic reports. PATIENT T Cautions About Interpreting PI Diagnostic Reports ■ A biopsy is the only definitive test for HL. ■ Some test results may be reported as “normal” even though HL is present. ■ Some test results may be reported as “abnormal” even though HL is not present. ■ Other conditions can produce signs and symptoms similar to HL. ■ The interpretation of test results such as imaging studies and scans can be lengthy and difficult in some situations. ■ Follow-up tests are often needed to determine the significance of previous results, and additional biopsies may be needed to clarify the results. ■ If patients wish to look at their written test reports, it is important for them to review the findings carefully with their doctor. 31 Understanding Hodgkin Lymphoma Chapter 4: Work-Up Before Treatment Can Begin After the initial diagnosis of Hodgkin lymphoma (HL), the doctor may order other tests such as blood tests, imaging studies, heart and lung function tests, a bone marrow biopsy or aspiration, and, less frequently, additional biopsies. This process is often called the work-up or staging studies. Some of these tests are needed to determine a patient’s disease stage, which is a measure of whether and how much the disease has spread to other parts of the body. Other tests check how the disease has affected a patient’s overall health and major organ functions. Together, these test results provide the information needed to help patients and their doctors decide on the best course of treatment. This chapter explains the reasons for the various tests, how these tests work, what to expect, and how HL is staged. What Tests Are Used in the Work-Up for HL? Patients with HL may undergo some or all of the following work-up tests before starting treatment. Many of these tests may be repeated during the course of treatment. ■ Physical examination with special attention to the size of the liver, spleen, and lymph nodes in the neck, underarms, and groin ■ Determination of general health status (also called performance status or functional status) to see how well a patient feels and how well he/she can carry out normal daily activities, such as getting washed and dressed, going to work, and doing chores. ■ Questioning about the presence of fever, night sweats, and weight loss (also called “B symptoms”) ■ Questioning about the presence of itching and pain, particularly in response to drinking alcohol Part 1 — Learning the Basics Learning the Basics 32 Part 1 ■ Questioning about human immunodeficiency virus (HIV) and cardiac disease ■ Complete blood count (CBC) with differential ■ Measurement of the erythrocyte sedimentation rate (ESR) ■ Comprehensive metabolic panel ■ Testing for infection with human immunodeficiency virus (HIV) and hepatitis viruses ■ Chest X-ray ■ Computed tomography (CT), magnetic resonance imaging (MRI), and/or positron emission tomography (PET) scans of the neck, chest, abdomen, and pelvis ■ Echocardiogram (ECHO) or multigated acquisition (MUGA) scan to evaluate heart function ■ Pulmonary studies to evaluate lung