What are the NCCN guidelines on the diagnosis of non-Hodgkin lymphoma (NHL)?

Updated: Feb 25, 2021
  • Author: Sanjay Vinjamaram, MD, MPH; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

The National Comprehensive Cancer Network (NCCN) recommendations for the diagnostic evaluation of non-Hodkgin lymphoma are as follows [26] :

  • Morphology and immunophenotyping is required for diagnosis according to the World Health Organization (WHO) classification

  • Incisional or excisional biopsy is preferred for the initial diagnosis; core needle biopsy is discouraged except for cases where a lymph node is not easily accessible

  • Fine needle aspiration is not an acceptable diagnostic tool; however, in selected circumstances it can be used in combination with immunohistochemistry and flow cytometry

  • Differential diagnosis is based on morphology and clinical features, which determine the choice of studies

  • A broad but limited panel of antibodies should be tested

  • Additional panels are added on the basis of initial results; unless clinically urgent, panels of unnecessary antibodies should be avoided

  • Genetic studies may be ordered as needed

  • Bone marrow biopsy is required when clonal lymphocytosis is identified by flow cytometry, except in chronic lymphocytic leukemia, where bone marrow biopsy is not necessary unless indicated because of cytopenias and suspicion for bone marrow involvement)


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