Diagnosis of non-Hodgkin's lymphomas
Last reviewed: 23.04.2024
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The complex of necessary diagnostic tests for suspected non-Hodgkin's lymphoma includes the following measures.
- Anamnesis and detailed examination with assessment of the size and consistency of all groups of lymph nodes.
- Clinical blood count with platelet count (deviations are more often absent, cytopenia is possible).
- Biochemical blood test with assessment of liver function, kidney function, determination of LDH activity, the increase of which has diagnostic value and characterizes tumor size.
- The bone marrow examination for the detection of tumor cells is a puncture from three points with myelogram counting; determine the percentage of normal and malignant cells, their immunophenotype.
- Lumbar puncture with morphological examination of the CSF cytopreparation for determining the CNS lesion (presence of tumor cells in the cerebrospinal fluid is possible).
A key element in the diagnosis of non-Hodgkin's lymphomas is the production of a tumor substrate. Standard surgical biopsies of the tumor are performed to obtain a sufficient amount of material. The character of the tumor is verified on the basis of cytological and histological examination with evaluation of morphology and immunohistochemistry, based on cytogenetic and molecular analysis.
In the presence of effusion in the pleural or abdominal cavity, a thoraco- or laparocentesis with a complex examination of the cells of the obtained fluid is shown. This study in some cases allows you to avoid surgical biopsy.
To determine the localization and prevalence of the lesion, the following imaging methods should be used.
- Radiography of chest organs (in two projections) allows to detect an increase in the thymus and lymph nodes of the mediastinum and their localization, the presence of pleurisy, foci in the lungs.
- Ultrasound of the abdominal and pelvic organs is carried out immediately if there is a suspicion of volumetric formation; the study allows to identify a tumor, ascites, foci in the liver, spleen.
To obtain more detailed information on the condition of the thoracic and abdominal striae, a CT scan is performed. CT or MRI is indicated if there are symptoms of CNS damage, bones. If there is a suspicion of bone damage, scanning with technetium and gallium is also used.
According to the indications, the otorhinolaryngologist, ophthalmologist and other specialists are consulted.
When suspected of non-Hodgkin's lymphoma, a tumor biopsy (thoraco- or laparocentesis) is considered an urgent operation, the preparation and analysis of the tumor substrate are necessary in the first two (at least three) days after hospitalization of the child in a specialized hospital. Surgical intervention should be as gentle as possible so that specific antitumor therapy can be started immediately.
All studies are conducted before the start of specific therapy, except for rare life-threatening situations (eg, compression syndrome).
[Staging of non-Hodgkin's lymphomas
The clinical stage determines the prevalence of the tumor process. The staging is carried out in accordance with the following criteria.
- Stage I. Single lymph node or extranodal tumor without local spread (with the exception of mediastinal, abdominal and epidural localization).
- Stage II. Several lymph nodes or extranodal tumors on one side of the diaphragm with or without local dissemination (with the exception of mediastinal and epidural localization). With macroscopically complete removal of the tumor, the stage is defined as a resected (II R), with the impossibility of complete removal - as a non-resected (II NR). These gradations are taken into account in determining the program of therapy.
- 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 lesion of the skeleton.
The majority of oncohematologists believe that the presence of less than 25% of tumor cells in the myelogram is the defeat of the bone marrow. If the number of blasts in the myelogram exceeds 25%, they diagnose acute leukemia. Subsequent verification of the diagnosis is carried out by means of a cytochemical study, immunophenotyping, cytogenetic and molecular analysis.