Burkitt's lymphoma diagnostic study of choice: Difference between revisions

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__NOTOC__
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{{Burkitt's lymphoma}}
{{Burkitt's lymphoma}}
{{CMG}}; {{AE}}
{{CMG}}; {{AE}}, {{kakbar}}
== Overview ==
== Overview ==
 
In Burkitts lymphoma [[Biopsy|tissue biopsy]] remains the preferred diagnostic study of choice. The [[biopsy]] will yield confirmatory results when [[histopathological]] and [[immunohistochemical]] techniques are used.
== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==
 
Biopsy of the affected [[lymph nodes]] remains to be the diagnostic study of choice which confirms Burkitts lymphoma.
=== Study of choice ===
=== Study of choice ===
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
* [[Lymph node]] or extra nodal tissue [[biopsy]] is diagnostic of Burkitt's lymphoma.
* To view the characteristic findings of Burkitt's lymphoma biopsy please click [[Burkitt's lymphoma pathophysiology #Microscopic Pathology|'''here''']].
==Staging==
According to the Murphy staging system, there are four stages of Burkitt's lymphoma based on the number of [[Lymph node|nodes]] involved and the extra nodal spread.


OR
Staging for Burkitt's lymphoma is provided in the following table:<ref name="pmid19074108">{{cite journal| author=Perkins AS, Friedberg JW| title=Burkitt lymphoma in adults. | journal=Hematology Am Soc Hematol Educ Program | year= 2008 | volume=  | issue=  | pages= 341-8 | pmid=19074108 | doi=10.1182/asheducation-2008.1.341 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19074108  }} </ref>


The following result of [gold standard test] is confirmatory of [disease name]:
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
* [Result 1]
|+ '''Murphy staging system'''
* [Result 2]
! style="background: #4479BA; color:#FFF;" | Stage
 
! style="background: #4479BA; color:#FFF;" | Features
OR
|-
 
| style="padding: 5px 5px; background: #F5F5F5;" | Stage I
[Name of the investigation] must be performed when:
| style="padding: 5px 5px; background: #F5F5F5;" |
* The patient presents with [symptom/sign 1], [symptom/sign 2], and [symptom/sign 3].
* Single [[Lymph node|nodal]] or extra nodal site involvement excluding [[mediastinum]] or [[abdomen]]<ref name="pmid22296338">{{cite journal| author=Sandlund JT| title=Burkitt lymphoma: staging and response evaluation. | journal=Br J Haematol | year= 2012 | volume= 156 | issue= 6 | pages= 761-5 | pmid=22296338 | doi=10.1111/j.1365-2141.2012.09026.x | pmc=3292702 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22296338  }} </ref>
* A [name of test] is positive for [sign 1], [sign 2], and [sign 3] in the patient.
|-
 
| style="padding: 5px 5px; background: #F5F5F5;" | Stage II
OR
| style="padding: 5px 5px; background: #F5F5F5;" |
 
* Single extra nodal [[tumor]] with regional nodal involvement
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
* Two extra nodal [[Tumor|tumors]] on one side of [[Thoracic diaphragm|diaphragm]]<ref name="pmid22296338">{{cite journal| author=Sandlund JT| title=Burkitt lymphoma: staging and response evaluation. | journal=Br J Haematol | year= 2012 | volume= 156 | issue= 6 | pages= 761-5 | pmid=22296338 | doi=10.1111/j.1365-2141.2012.09026.x | pmc=3292702 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22296338  }} </ref>
 
* Primary [[Gastrointestinal tract|gastrointestinal]] [[tumor]] with or without associated [[Mesentery|mesenteric]] nodes
OR
* Two or more nodal areas on one side of [[diaphragm]]
 
|-
The diagnostic study of choice for [disease name] is [name of the investigation].
| style="padding: 5px 5px; background: #F5F5F5;" | Stage IIR
 
| style="padding: 5px 5px; background: #F5F5F5;" |
OR
* Completely resected intra-abdominal disease
 
|-
There is no single diagnostic study of choice for the diagnosis of [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" | Stage III
 
| style="padding: 5px 5px; background: #F5F5F5;" | 
OR
* Two single extra nodal [[tumors]] on opposite sides of [[diaphragm]] <ref name="pmid22296338">{{cite journal| author=Sandlund JT| title=Burkitt lymphoma: staging and response evaluation. | journal=Br J Haematol | year= 2012 | volume= 156 | issue= 6 | pages= 761-5 | pmid=22296338 | doi=10.1111/j.1365-2141.2012.09026.x | pmc=3292702 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22296338  }} </ref>
 
* All primary intra thoracic [[tumors]]
There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
* All paraspinal or [[epidural]] [[tumors]]
 
* All extensive primary intra-abdominal disease
OR
* Two or more nodal areas on opposite sides of [[diaphragm]]
 
[Disease name] is primarily diagnosed based on the clinical presentation.
 
OR
 
Investigations:
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
 
==== The comparison of various diagnostic studies for [disease name] ====
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="padding: 5px 5px; background: #F5F5F5;" | Stage IIIA
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
* Localized, non-resectable [[abdominal]] disease
|-
| style="padding: 5px 5px; background: #F5F5F5;" | Stage IIIB
| style="padding: 5px 5px; background: #F5F5F5;" |  
* Widespread multi organ [[abdominal]] disease
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="padding: 5px 5px; background: #F5F5F5;" | Stage IV
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="padding: 5px 5px; background: #F5F5F5;" |  
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
* Initial [[CNS]] or [[bone marrow]] involvement (< 25%)
|}
|}
<small> [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity</small>


===== Diagnostic results =====
===== Diagnostic results =====
The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:
The following finding(s) on performing biopsy and [[Fluorescence in situ hybridization|FISH]] are confirmatory for Burkitts lymphoma :
* [Finding 1]
* [[Myc|C-MYC]] ([[Fluorescence in situ hybridization|FISH]])<ref name="pmid24079473">{{cite journal| author=Aquino G, Marra L, Cantile M, De Chiara A, Liguori G, Curcio MP et al.| title=MYC chromosomal aberration in differential diagnosis between Burkitt and other aggressive lymphomas. | journal=Infect Agent Cancer | year= 2013 | volume= 8 | issue= 1 | pages= 37 | pmid=24079473 | doi=10.1186/1750-9378-8-37 | pmc=3850004 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24079473  }} </ref>
* [Finding 2]
* Starry-sky pattern ([[histopathological]] specimen)<ref name="pmid25351551">{{cite journal| author=Andrade-Filho Jde S| title=Analogies in medicine: starry-sky appearance. | journal=Rev Inst Med Trop Sao Paulo | year= 2014 | volume= 56 | issue= 6 | pages= 541-2 | pmid=25351551 | doi= | pmc=4296877 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25351551  }} </ref>
 
===== Sequence of Diagnostic Studies =====
The [name of investigation] must be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.
 
OR
 
The various investigations must be performed in the following order:
* [Initial investigation]
* [2nd investigation]
 
=== Name of Diagnostic Criteria ===
 
'''It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.'''
 
[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
 
OR
 
There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
 
OR
 
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
 
OR
 
The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
[Disease name] may be diagnosed at any time if one or more of the following criteria are met:
* Criteria 1
* Criteria 2
* Criteria 3
 
OR
 
'''IF there are clear, established diagnostic criteria'''
 
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
 
OR
 
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
'''IF there are no established diagnostic criteria'''
 
There are no established criteria for the diagnosis of [disease name].


==References==
==References==

Latest revision as of 23:07, 18 January 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: , Kamal Akbar, M.D.[2]

Overview

In Burkitts lymphoma tissue biopsy remains the preferred diagnostic study of choice. The biopsy will yield confirmatory results when histopathological and immunohistochemical techniques are used.

Diagnostic Study of Choice

Biopsy of the affected lymph nodes remains to be the diagnostic study of choice which confirms Burkitts lymphoma.

Study of choice

  • Lymph node or extra nodal tissue biopsy is diagnostic of Burkitt's lymphoma.
  • To view the characteristic findings of Burkitt's lymphoma biopsy please click here.

Staging

According to the Murphy staging system, there are four stages of Burkitt's lymphoma based on the number of nodes involved and the extra nodal spread.

Staging for Burkitt's lymphoma is provided in the following table:[1]

Murphy staging system
Stage Features
Stage I
Stage II
Stage IIR
  • Completely resected intra-abdominal disease
Stage III
Stage IIIA
Stage IIIB
Stage IV
Diagnostic results

The following finding(s) on performing biopsy and FISH are confirmatory for Burkitts lymphoma :

References

  1. ↑ Perkins AS, Friedberg JW (2008). "Burkitt lymphoma in adults". Hematology Am Soc Hematol Educ Program: 341–8. doi:10.1182/asheducation-2008.1.341. PMID 19074108.
  2. ↑ 2.0 2.1 2.2 Sandlund JT (2012). "Burkitt lymphoma: staging and response evaluation". Br J Haematol. 156 (6): 761–5. doi:10.1111/j.1365-2141.2012.09026.x. PMC 3292702. PMID 22296338.
  3. ↑ Aquino G, Marra L, Cantile M, De Chiara A, Liguori G, Curcio MP; et al. (2013). "MYC chromosomal aberration in differential diagnosis between Burkitt and other aggressive lymphomas". Infect Agent Cancer. 8 (1): 37. doi:10.1186/1750-9378-8-37. PMC 3850004. PMID 24079473.
  4. ↑ Andrade-Filho Jde S (2014). "Analogies in medicine: starry-sky appearance". Rev Inst Med Trop Sao Paulo. 56 (6): 541–2. PMC 4296877. PMID 25351551.

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