Canterbury DHB
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Establishing the precise diagnosis requires high quality diagnostic material and usually a formal lymph node biopsy. Fine needle aspirate is not sufficient for NHL diagnosis, although needle biopsy may be sufficient if the disease is inaccessible.
A patient may be referred for surgical biopsy by letter to General Surgery or ENT (for neck lumps) as appropriate, or to Interventional radiology (after discussion with Dr Coates or another interventional radiologist) if there is no surgically accessible tissue. All these services will prioritise patients promptly.
Formalin fixed tissue and fresh tissue are required, either in a dry sterile container or placed in sterile saline. Conventional histological examination by H&E staining methods needs to be supplemented by immunophenotyping of paraffin embedded sections. Immunophenotyping of frozen sections, flow cytometry, cytogenetics, and DNA analysis on cell suspensions may all be required.
Note: A lymph node biopsy specimen is also appropriate for FISH cytogenetics studies which are valuable to confirm (t(11;14) in mantle cell lymphoma and gene rearrangements in double hit DLBCL. Bone marrow may be uninformative and is often not required in the staging of Hodgkin lymphoma – see Painter, D., Smith, A. (2015). "The clinical impact of staging bone marrow examination on treatment decisions and prognostic assessment of lymphoma patients." British Journal of Haematology 170: 175-8.
Accurate diagnosis may involve integrating all or many of the above techniques.
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Topic Code: 5945
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