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Diagnosis of non-Hodgkin's lymphoma
Last reviewed: 03.07.2025
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The complex of necessary diagnostic studies in case of suspected non-Hodgkin's lymphoma includes the following measures.
- Collection of anamnesis and detailed examination with assessment of the size and consistency of all groups of lymph nodes.
- Clinical blood test with platelet count (usually no abnormalities, cytopenia is possible).
- Biochemical blood test with assessment of liver and kidney function, determination of LDH activity, an increase of which has diagnostic value and characterizes the size of the tumor.
- Bone marrow examination to detect tumor cells - puncture from three points with myelogram calculation; determines the percentage of normal and malignant cells, their immunophenotype.
- Lumbar puncture with morphological examination of the cerebrospinal fluid cytopreparation to determine damage to the central nervous system (possible presence of tumor cells in the cerebrospinal fluid).
The key element of non-Hodgkin's lymphoma diagnostics is obtaining a tumor substrate. A surgical tumor biopsy is routinely performed to obtain a sufficient amount of material. The tumor's nature is verified based on cytological and histological examination with an assessment of morphology and immunohistochemistry, based on cytogenetic and molecular analysis.
In the presence of effusion in the pleural or abdominal cavity, thoraco- or laparocentesis with a comprehensive study of the cells of the obtained fluid is indicated. This study in some cases allows avoiding surgical biopsy.
To determine the location and extent of the lesion, the following imaging methods must be used.
- X-ray of the chest organs (in two projections) allows us to detect an enlargement of the thymus and mediastinal lymph nodes and their localization, the presence of pleurisy, and foci in the lungs.
- An ultrasound of the abdominal and pelvic organs is performed immediately if a volumetric formation is suspected; the examination allows for the detection of a tumor, ascites, foci in the liver and spleen.
To obtain more detailed information about the condition of the chest and abdominal cavity, CT is indicated. CT or MRI is indicated in the presence of symptoms of damage to the central nervous system, bones. If bone damage is suspected, scanning with technetium, gallium is also used.
Depending on the indications, consultations with an otolaryngologist, ophthalmologist and other specialists are conducted.
If non-Hodgkin's lymphoma is suspected, tumor biopsy (thoraco- or laparocentesis) is considered an urgent operation; obtaining and analyzing the tumor substrate is necessary in the first two (or at least three) days after the child's hospitalization in a specialized hospital. Surgical intervention should be as gentle as possible so that specific antitumor therapy can be started immediately.
All studies are performed before the start of specific therapy, except for rare life-threatening situations (eg, compartment syndrome).
[ Staging of non-Hodgkin's lymphomas
The clinical stage is determined by the extent of the tumor process. Staging is carried out in accordance with the following criteria.
- Stage I. Solitary lymph node or extranodal tumor without local spread (except mediastinal, abdominal and epidural localization).
- Stage II. Several lymph nodes or extranodal tumors on one side of the diaphragm with or without local spread (except for mediastinal and epidural localization). If the tumor is macroscopically completely removed, the stage is defined as resected (II R), if complete removal is impossible - as unresected (II NR). These gradations are taken into account when determining the therapy program.
- Stage III. Tumor formations on both sides of the diaphragm, intrathoracic, paraspinal and epidural tumor localization, extensive unresectable intra-abdominal tumor.
- Stage IV. Any localization of the primary tumor with involvement of the central nervous system, bone marrow and/or multifocal skeletal involvement.
Most oncohematologists consider the presence of less than 25% tumor cells in the myelogram to be a bone marrow lesion. If the number of blasts in the myelogram exceeds 25%, a diagnosis of acute leukemia is made. Subsequent verification of the diagnosis is carried out by cytochemical testing, immunophenotyping, cytogenetic and molecular analysis.