What are the NCCN recommendations for the workup of non-Hodgkin lymphoma (NHL)?

Updated: Jun 12, 2019
  • Author: Priyank P Patel, MD; Chief Editor: Emmanuel C Besa, MD  more...
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The National Comprehensive Cancer Network (NCCN) recommendations for the diagnostic evaluation of non-Hodgkin lymphomas are as follows [1, 2] :

  • Excisional or incisional biopsy is required

  • Fine needle aspiration (FNA) biopsy alone is not generally suitable for the initial diagnosis of lymphoma

  • A core needle biopsy is not optimal but can be used under certain circumstances

  • In certain circumstances, when a lymph node is not easily accessible for excisional or incisional biopsy, a combination of core biopsy and FNA biopsies in conjunction with appropriate ancillary techniques for the differential diagnosis  (immunohistochemistry, flow cytometry, PCR for IGHV and TCR  gene rearrangements, karyotype, and fluorescence in situ hybridization [FISH] for major translocations) may be sufficient for diagnosis.

    • Histologic grading cannot be performed on an FNA.

    • Hematopathology review of all slides with at least one paraffin block representative of the tumor should be performed

  • Rebiopsy if consult material is nondiagnostic

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