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Investigations and diagnosis

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

investigations

Diagnostic investigations include:

  • incisional or excisional lymph node biopsy is recommended to establish the diagnosis of NHL
    • core biopsies are usually discouraged and considered if it is the only safe means of obtaining diagnostic tissue
  • adequate immunophenotyping to establish diagnosis

  • diagnosing B-cell lymphomas: gene testing strategies (2)
    • consider using FISH (fluorescence in situ hybridisation) to identify a MYC rearrangement in all people newly presenting with histologically high-grade B-cell lymphoma
    • if a MYC rearrangement is found, use FISH to identify the immunoglobulin partner and the presence of BCL2 and BCL6 rearrangements

Other workup procedures include:

  • full blood count
  • urea and electrolytes
  • lactate dehydrogenase (LDH)
  • screening tests e.g. - hepatitis B
  • β2-microglobulin
  • CT of neck, chest, abdomen & pelvis
  • bone marrow biopsy with or without aspirate
  • pregnancy testing in women of child-bearing age (if chemotherapy planned (1))

Notes (2):

  • staging using FDG-PET-CT (fluorodeoxyglucose-positron emission tomography-CT)
    • confirming staging
      • offer FDG-PET-CT imaging to confirm staging for people diagnosed with:
        • stage I diffuse large B-cell lymphoma by clinical and CT criteria
        • stage I or localised stage II follicular lymphoma if disease is thought to be encompassable within a radiotherapy field
        • stage I or II Burkitt lymphoma with other low-risk features
  • end-of-treatment assessment
    • offer FDG-PET-CT imaging to assess response at completion of planned treatment for people with:
      • diffuse large B-cell lymphoma
      • Burkitt lymphoma.

Reference:

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