In Hodgkin's lymphoma, which lymph node region is most commonly involved initially?

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Hodgkin lymphoma often begins with painless enlargement of a lymph node or a chain of nodes, and the neck is the most common first site. The head and neck lymphatic drainage typically involves the cervical nodes early, so these nodes are most frequently the initial presentation. While the mediastinum can be involved and may show prominence on imaging, the first clinically evident enlargement tends to be in the cervical region. Inguinal or axillary nodes can become involved as the disease spreads, but they are less commonly the initial site compared with cervical nodes. Therefore, cervical lymph nodes are the best choice.