Non-Hodgkin lymphoma diagnostic study of choice
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2]; Associate Editor(s)-in-Chief: Sowminya Arikapudi, M.B,B.S. [3]
Overview
The diagnostic study of choice for non-Hodgkin lymphoma is excisional lymph node biopsy. A bone marrow biopsy is an alternative to a lymph node biopsy.
Diagnostic study of choice
- The diagnostic study of choice for non-Hodgkin's lymphoma is excisional lymph node biopsy. An excisional biopsy is needed because it preserves the architecture of the lymph node and allows for precise determination of the type of lymphoma. Fine needle aspiration biopsy is insufficient. In addition to light microscopy evaluation of the excisional biopsy samples, the immunophenotypic analysis with immunohistochemistry helps to determine non-Hodgkin's lymphoma subtypes and distinguish non-Hodgkin's lymphoma from T cell rich large B cell lymphoma and anaplastic large cell lymphoma. The presence of CD20 positive clonal B cells defines non-Hodgkin lymphoma. Flow cytometry is an effective method in differentiating between Hodgkin's lymphoma and non-Hodgkin lymphoma, as well as subtypes of non-Hodgkin lymphoma.
- A bone marrow biopsy can also be done to diagnose non-Hodgkin lymphoma if there is sufficient evidence of marrow involvement (i.e. presence of cytopenias). Non-Hodgkin lymphoma cells originate in the bone marrow, which is the site of B cell production and maturation. A length of 2cm of the core biopsy is generally needed for diagnosis, which is in contrast to diagnostic requirements for leukemias. A bone marrow is not the diagnostic study of choice for Hodgkin lymphoma if a lymph node can be biopsied.