From the Guidelines
Laboratory tests for lymphoma diagnosis should include a complete blood count, routine blood chemistry, lactate dehydrogenase (LDH), and uric acid, as well as screening tests for HIV, hepatitis B virus (HBV), and HCV, according to the most recent guidelines 1.
Initial Laboratory Tests
- Complete blood count (CBC)
- Routine blood chemistry
- Lactate dehydrogenase (LDH)
- Uric acid
- Screening tests for HIV, HBV, and HCV
Diagnostic Imaging
- Fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography (CT) scan is recommended as the gold standard for staging DLBCL patients 1
- Contrast-enhanced CT (CeCT) may be necessary for a better delineation of lymphadenopathy from the bowel or for detecting compression/thrombosis of central/mediastinal vessels
Biopsy and Histopathology
- Excisional biopsy is preferred for diagnosis, although core-needle biopsy may suffice when not feasible 1
- Adequate immunophenotyping to establish diagnosis, including flow cytometry and immunohistochemistry 1
Staging and Risk Assessment
- The Lugano classification is recommended for staging and restaging of lymphoma 1
- Bone marrow biopsy is no longer indicated in patients undergoing PET-CT evaluation, unless PET-CT is negative and identifying a discordant histology is important for patient management 1
From the Research
Laboratory Tests for Lymphoma Diagnosis
The following laboratory tests are used for lymphoma diagnosis:
- Bone marrow biopsy (BMB) 2, 3, 4
- Flow cytometric analysis (FCM) 2, 5
- Bone marrow clot examination 2
- Bone marrow smear 2
- Positron emission tomography/computed tomography (PET/CT) scan 3, 4
- Fine needle aspiration (FNA) or cell suspension/imprints from fresh tissue for cytology associated with FCM (C-FCM) 5
- Open lymph node biopsy 6
- Histological examination 5
Diagnostic Accuracy of Laboratory Tests
The diagnostic accuracy of these tests varies:
- The combination of BMB and FCM has been shown to have a high hazard ratio and c-index for detecting bone marrow involvement in diffuse large B-cell lymphoma (DLBCL) patients 2
- PET/CT scan has been found to have good sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy in detecting bone marrow involvement in DLBCL patients 3, 4
- C-FCM has been shown to have a good concordance with histological diagnosis, with a concordance rate of 85-90% 5
Comparison of Laboratory Tests
The following comparisons have been made between laboratory tests:
- BMB and PET/CT scan have been compared, with PET/CT scan detecting more bone marrow involvement in DLBCL and Hodgkin lymphoma patients 3
- BMB and FCM have been compared, with the combination of both tests having a higher hazard ratio and c-index for detecting bone marrow involvement in DLBCL patients 2
- C-FCM and histological examination have been compared, with C-FCM having a good concordance with histological diagnosis 5