How is diffuse large B-cell lymphoma (DLBCL) diagnosed?

Updated: Aug 20, 2020
  • Author: Shipra Gandhi, MBBS; Chief Editor: Emmanuel C Besa, MD  more...
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Lab studies

Lab studies used in the diagnosis and assessment of diffuse large cell lymphoma include the following:

  • Complete blood count: To evaluate involvement of the bone marrow, which may result in anemia, thrombocytopenia, and/or leukopenia
  • Serum electrolyte levels: Electrolyte abnormalities may occur from renal involvement with lymphoma
  • Lactate dehydrogenase and uric acid levels: Elevated levels correspond with the tumor burden
  • Hepatitis B testing: Performed in patients undergoing combination chemoimmunotherapy with rituximab (risk of activation)
  • Flow cytometry: Helps in determining a clonal cell population and in differentiating between B- and T-cell origins

Imaging studies

Imaging studies used in the diagnosis and assessment of diffuse large cell lymphoma include the following:

  • Gastrointestinal imaging: Upper and lower gastrointestinal series indicated in patients with gastrointestinal symptoms, but these studies [2]

  • Central nervous system imaging: Patients with CNS symptoms require brain evaluation with CT scanning with contrast or MRI with gadolinium

  • Bone imaging: Bone scan for patients with unexplained bone pain or elevated alkaline phosphatase levels

  • CT scanning of the neck, chest, abdomen, and pelvis: To help identify degree of lymphadenopathy, presence of extranodal disease, or visceral involvement

  • Gallium-67 scanning - Valuable in staging diffuse large cell lymphomas

  • Multigated acquisition scanning: To evaluate the patient's ejection fraction before chemotherapy

  • Positron emission tomography: To stage disease using fluorodeoxyglucose

Biopsy and lumbar puncture

Bone marrow aspiration and biopsy are performed as part of the staging process to help rule out involvement with lymphoma. Lymph node biopsy is required to establish a definitive diagnosis of NHL. The diagnosis of diffuse large cell lymphoma is usually confirmed after positive findings are obtained from a lymph node biopsy specimen.

In patients with advanced-stage disease, a lumbar puncture for cytologic and chemical analysis of the CSF may be necessary.

See Workup for more detail.

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