Lymphoma Evaluation and Staging

Initial Diagnostic Evaluation

• The American Society of Clinical Oncology recommends obtaining a comprehensive history focusing on constitutional symptoms, such as fevers, night sweats, and unexplained weight loss, as well as specific symptoms like fatigue and pruritus, in patients with suspected lymphoma 1, 3
• A physical examination should include measurement of all accessible lymph node groups and assessment of spleen and liver size, as recommended by the American Society of Clinical Oncology 1, 4
• Complete necessary laboratory tests for determination of prognostic indices specific to lymphoma subtypes and assessment of comorbidities, as suggested by the American Society of Clinical Oncology 1, 3

Pathologic Diagnosis

• The American Society of Clinical Oncology strongly prefers an excisional or incisional biopsy for initial diagnosis, as fine-needle aspiration is inadequate for initial diagnosis 2, 5
• Diagnosis requires comprehensive evaluation by an experienced lymphoma pathologist, including morphology, immunohistochemistry, flow cytometry, and molecular studies, as recommended by the American Society of Clinical Oncology 2, 5

Imaging and Staging

• The American Society of Clinical Oncology recommends PET-CT as the gold standard for staging FDG-avid nodal lymphomas, while CT scan is preferred for non-FDG-avid lymphomas 1, 3
• Site-specific assessment should include PET-CT for FDG-avid histologies and CT for non-avid disease, as suggested by the American Society of Clinical Oncology 4
• The Ann Arbor staging system remains the foundation for classification, and the Lugano classification incorporates modern imaging findings into staging, as recommended by the American Society of Clinical Oncology 5, 6

Staging Classification

• Staging should include assessment of disease location and extent, presence of bulky disease, and presence of B symptoms, as recommended by the American Society of Clinical Oncology 1, 5, 6

Common Pitfalls to Avoid

• The American Society of Clinical Oncology advises against relying solely on physical examination for lymph node assessment and using fine-needle aspiration as the sole diagnostic procedure 2
• Failing to obtain adequate tissue for comprehensive pathologic evaluation and not performing baseline PET-CT before therapy in FDG-avid lymphomas can compromise accurate response assessment, as warned by the American Society of Clinical Oncology 1, 2, 5