Diagnosis of Non-Hodgkin's Lymphoma

Diagnostic Testing for Non-Hodgkin's Lymphoma

Medical History and Physical Examination

  • The physician will take a thorough medical history to uncover any signs/symptoms of non-Hodgkin's lymphoma as well as determine any possible risk factors for the disease.

  • A complete physical examination of the patient is then performed by the physician who will pay particular attention to the presence of swollen lymph nodes and possible enlargement of the liver and/or spleen.

Laboratory Evaluation

Your physician will also take a sample of your blood and submit it to the laboratory for further studies including:

  • Complete blood count (CBC)
  • Comprehensive metabolic panel to monitor electrolytes and assess kidney and liver function
  • Measurement of levels of specific blood components (LDH, uric acid, and beta-2 microglobulin) to determine the tumor burden (the amount of cancer cells that are present in the body).
  • HIV testing is standard of care in working-up patients with non-Hodgkin's lymphoma and Hodgkin's lymphoma. Using standard chemotherapy regimens on individuals who are HIV-positive can lead to serious complications or death. Your physician is not necessarily ordering an HIV test because he/she believes that you have AIDS but is rather trying to provide optimal care and treatment.

Imaging Studies

  • Chest X-ray
  • Computed tomography (CT) of the chest, abdomen, and pelvis
  • In some cases, specialized imaging studies such as a gallium scan or, more often, positron emission tomography (PET) imaging may be recommended for the staging of non-Hodgkin's lymphoma or Hodgkin's lymphoma.

Lymph Node Biopsy

In cases where an enlarged lymph node persists for 6-weeks or longer and the physician suspects lymphoma, a lymph node biopsy will be required and the tissue will be submitted to a pathology laboratory to determine the presence or absence of lymphoma cells. Lymph node biopsy is the only definitive way to diagnose non-Hodgkin's lymphoma and several different biopsy procedures are available. Before undergoing a lymph node biopsy, you will want to discuss with your surgeon in detail the various biopsy options including the advantages and disadvantages of each technique as well as the potential risks and complications. In general, the biopsy techniques available for the diagnosis of non-Hodgkin's lymphoma include:

  • Surgical Biopsy - either the entire lymph node or a piece of the lymph node is removed surgically. The biopsy specimen is then submitted to the pathology laboratory and examined under a microscope to look for the presence of lymphoma cells.

  • Fine Needle Aspiration (FNA) Biopsy - a very thin needle (biopsy needle) is inserted into the area of the tumor and tissue is withdrawn into a syringe. The biopsy specimen is then submitted to the pathology laboratory and examined under a microscope to look for the presence of lymphoma cells.

  • Large Needle/Core Biopsy - This technique uses a large-bore needle to obtain a sample of tissue but is not widely used for the diagnosis of non-Hodgkin's lymphoma. It is usually reserved for patients who cannot tolerate a surgical biopsy.

  • Other Biopsy Procedures - Once lymphoma has been diagnosed, your physician may recommend additional biopsy procedures to help determine the stage or the extent of spread of the disease. These may include a bone marrow biopsy to determine if the lymphoma has spread to the bone marrow, and a lumbar puncture (spinal tap) to determine if the lymphoma has affected the central nervous system (brain and spinal cord).

Special Laboratory Tests

Tissue samples removed at the time of biopsy from patients with non-Hodgkin's lymphoma will be also subjected to several special tests in the pathology laboratory to help doctors identify the type of non-Hodgkin's lymphoma that is causing the disease. These tests include:

  • Immunophenotyping - This special immunological test uses antibodies to detect and identify specific markers called "antigens" that may be present on the surface of lymphoma cells. If certain surface antigens are identified, the oncologist may choose to use monoclonal antibodies such as rituximab (Rituxan) to treat the lymphoma.

  • Cytogenetics - Lymphoma cells are examined under a microscope to look for abnormalities in the chromosomes such as DNA translocations or extra pairs of chromosomes.