Investigations and diagnosis

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:

1. Zelenetz AD et al. Non-Hodgkin's lymphomas. J Natl Compr Canc Netw. 2011;9(5):484-560.
2. NICE. Non-Hodgkin’s lymphoma: diagnosis and management. NICE guideline NG52. Published July 2016