What is the diagnostic approach for checking for lymphoma?

From the Guidelines

The diagnostic approach for lymphoma should start with a thorough medical history and physical examination, followed by a lymph node biopsy, which is the gold standard for diagnosis, as recommended by the Lugano classification 1. The diagnostic workup for lymphoma involves several key steps:

• A thorough medical history and physical examination to identify symptoms like persistent swelling of lymph nodes, unexplained fever, night sweats, and weight loss.
• Blood tests to assess complete blood count, liver and kidney function, and specific markers like lactate dehydrogenase (LDH).
• A lymph node biopsy, which can be an excisional biopsy (removing an entire lymph node) or a core needle biopsy, as stated in the NCCN clinical practice guidelines 1.
• Imaging studies such as CT scans, PET scans, or MRIs to determine the extent of disease spread (staging), with PET-CT being the standard for FDG-avid lymphomas 1.
• Bone marrow biopsy may also be performed to check if lymphoma has invaded the bone marrow, although it is not always necessary, especially if a PET-CT is performed 1.
• Additional specialized tests include immunophenotyping, flow cytometry, and cytogenetic analysis to identify the specific lymphoma subtype, which is crucial for determining the appropriate treatment approach, as outlined in the ESMO clinical practice guidelines 1. This comprehensive diagnostic workup allows oncologists to accurately classify the lymphoma type and stage, enabling them to develop the most effective treatment plan for each patient. Some key points to consider in the diagnostic workup include:
• The use of a paraffin panel with specific markers such as CD20, CD3, CD5, CD10, BCL2, and BCL6, as recommended by the NCCN guidelines 1.
• The importance of histologic grading, which cannot be performed on an FNA, as stated in the NCCN guidelines 1.
• The need for a thorough staging and risk assessment, including a CT-scan of the abdomen, a chest X-ray or a CT-scan of the chest, and a bone marrow aspirate and biopsy, as recommended by the ESMO guidelines 1.

From the Research

Diagnostic Approach for Lymphoma

The diagnostic approach for lymphoma typically involves a combination of physical examination, medical history, laboratory tests, and imaging studies.

• Lymphoma is a group of malignant neoplasms of lymphocytes with more than 90 subtypes, and it is traditionally classified broadly as non-Hodgkin or Hodgkin lymphoma 2.
• The presentation of lymphoma can vary, but it typically presents as painless adenopathy, with systemic symptoms of fever, unexplained weight loss, and night sweats occurring in more advanced stages of the disease 2.

Imaging Studies

Imaging studies play a crucial role in the diagnosis and staging of lymphoma.

• Positron emission tomography (PET) is more accurate than computed tomography (CT) in staging and restaging of lymphoma, but both are considered necessary 3.
• Combined PET and low-dose, noncontrast CT scanning can obviate the need for additional diagnostic contrast-enhanced CT scans in patients undergoing staging or restaging for lymphoma 3.
• The Lugano classification system incorporates symptoms and the extent of the disease as shown on positron emission tomography/computed tomography to stage lymphoma 2.

Biopsy and Staging

• An open lymph node biopsy is preferred for diagnosis 2.
• Bone marrow biopsy (BMB) and fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) are useful techniques to detect bone marrow involvement (BMI) in patients with lymphoma 4.
• PET/CT and BMB results can be concordant or discordant, and the use of both diagnostic assays along with clinical and laboratory findings can be useful for predicting BMI 4.

Treatment and Monitoring

• The treatment of lymphoma depends on the subtype and stage of the disease, and chemotherapy treatment plans differ between the main subtypes of lymphoma 2.
• Patients with lymphoma require routine surveillance to monitor for complications and relapse, in addition to age-appropriate screenings recommended by the U.S. Preventive Services Task Force 2.
• PET/CT has emerged as the modality of choice for treatment strategy assessments in patients with lymphoma, and its ability to characterize masses as benign or malignant and its high sensitivity and specificity for staging, restaging, and treatment monitoring have led to widespread acceptance of PET imaging for managing patients with lymphoma 5.