Lymphoma Screening and Staging Guidelines

Initial Diagnostic Approach

PET-CT is superior to conventional CT for detecting both nodal and extranodal disease sites in lymphoma, leading to more accurate staging, as recommended by the American Society of Clinical Oncology 1, 2
For FDG-avid lymphomas, PET-CT should be the primary imaging modality, according to the National Comprehensive Cancer Network 1, 2

PET-CT is mandatory for accurate staging, as stated by the European Society for Medical Oncology 3, 4
PET-CT can replace bone marrow biopsy in Hodgkin lymphoma as it is more sensitive for detecting bone marrow involvement, according to the American Society of Clinical Oncology 1, 2
Interim PET assessment during treatment may identify poor-risk patients, though treatment modification based on interim PET should be limited to clinical trials, as recommended by the European Society for Medical Oncology 4

PET-CT is strongly recommended for initial staging and treatment response evaluation, according to the European Society for Medical Oncology 5
PET-CT leads to more accurate staging than CT alone, with stage changes in 10-30% of patients, as stated by the American Society of Clinical Oncology 1, 2

PET-CT is recommended for routine staging, according to the European Society for Medical Oncology 6
PET-CT is mandatory to confirm localized stage I/II disease before involved-site radiotherapy (ISRT), as recommended by the European Society for Medical Oncology 6

PET-CT scan and/or chest/abdominal/pelvic CT with contrast of diagnostic quality are essential during workup, as stated by the National Comprehensive Cancer Network 7

The 5-point Deauville scale should be used for PET-CT response assessment in FDG-avid lymphomas, according to the American Society of Clinical Oncology 8
Complete metabolic response on PET-CT, even with a persistent mass, is considered a complete remission, as stated by the American Society of Clinical Oncology 8
Routine surveillance scans after achieving remission are discouraged, especially for DLBCL and Hodgkin lymphoma, as recommended by the American Society of Clinical Oncology 8

Excisional or incisional lymph node biopsy is preferred for initial diagnosis; core needle biopsy may be considered when excisional biopsy is not possible, according to the American Society of Clinical Oncology 2
Complete blood count, routine blood chemistry including LDH, β2-microglobulin, and screening for HIV, HBV, and HCV are required, as stated by the European Society for Medical Oncology 9, 6
Bone marrow biopsy remains important for many non-Hodgkin lymphomas, even with PET-CT imaging, according to the American Society of Clinical Oncology 2

False-positive rate with PET scans exceeds 20%, which can lead to unnecessary investigations, radiation exposure, biopsies, and patient anxiety, as stated by the American Society of Clinical Oncology 8
Relying solely on CT for FDG-avid lymphomas may result in understaging and potentially suboptimal treatment, according to the American Society of Clinical Oncology 1
Routine surveillance imaging in remission patients has not been shown to improve survival outcomes and may lead to unnecessary procedures, as recommended by the American Society of Clinical Oncology 8