From the Guidelines
Testing for lymphoma should involve a combination of physical examination, imaging studies, and a biopsy, with the most definitive test being an excisional or incisional biopsy, as recommended by the most recent guidelines 1. The diagnosis of lymphoma typically involves a combination of the following tests:
- Physical examination to check for swollen lymph nodes
- Imaging studies such as CT scans, PET scans, or MRIs to visualize lymph nodes throughout the body
- Biopsy, which can be done through a needle biopsy, excisional biopsy, or incisional biopsy, to examine a sample of tissue under a microscope Additional tests may include:
- Blood tests to check for abnormal cell counts and markers
- Bone marrow biopsy if there's concern about lymphoma spreading to the bone marrow
- Immunophenotyping to identify specific lymphoma types
- Staging procedures to determine how far the lymphoma has spread These tests help oncologists determine the specific type of lymphoma (Hodgkin or non-Hodgkin, and subtypes) and its stage, which guides treatment decisions, as outlined in the guidelines for diagnosis, treatment, and follow-up of lymphoma 1. It's worth noting that the distinction between different subtypes of lymphoma, such as germinal center-like subtype and activated B-cell-like subtype, may not influence treatment choices at the moment, as stated in the guidelines for diffuse large B-cell lymphoma 1. In terms of specific diagnostic work-up, the guidelines recommend a combination of medical history, physical examination, imaging studies, and biopsy, as well as screening for hepatitis B, hepatitis C, and human immunodeficiency virus (HIV) 1. Overall, early detection through appropriate testing is crucial for effective lymphoma management, and a biopsy is the most definitive test for diagnosing lymphoma 1.
From the Research
Testing for Lymphoma
- 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 diagnosis of lymphoma typically involves a combination of laboratory tests, imaging studies, and biopsy results, with an open lymph node biopsy being the preferred method for diagnosis 2.
- The Lugano classification system incorporates symptoms and the extent of the disease as shown on positron emission tomography/computed tomography to stage lymphoma, which is then used to determine treatment 2.
Diagnostic Tests
- Laboratory tests, such as complete blood count and peripheral blood flow cytometry, can help raise concern for lymphoma and guide further diagnosis 3.
- Imaging modalities, including positron emission tomography/computed tomography, can help stage lymphoma and determine the extent of the disease 2, 4.
- Lymph node sampling, such as a biopsy, is essential for confirming the diagnosis of lymphoma and determining the subtype 5, 3.
Staging and Treatment
- The staging of lymphoma is crucial in determining the treatment approach, with the Lugano classification system being widely used 2.
- Treatment plans differ between the main subtypes of lymphoma, with non-Hodgkin lymphoma being treated with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) with or without rituximab (R-CHOP), and Hodgkin lymphoma being treated with combined chemotherapy and radiotherapy 2.
- Positron emission tomography-directed therapy has been shown to improve outcomes and decrease toxicity in patients with limited-stage diffuse large B-cell lymphoma 6.