Fine Needle Aspiration/Core Needle Biopsy

A doctor may first request a "fine needle aspiration" or a "core needle biopsy" to evaluate the reason for an abnormality he or she finds on a physical examination or radiology testing.  However, a fine needle aspiration is usually inadequate to establish the best diagnosis for a non-Hodgkin lymphoma, and a core needle biopsy is usually a minimum requirement in order to perform special tests needed to determine the type of non-Hodgkin lymphoma present. In both procedures, a doctor, often a radiologist, may use a CT scan or an ultrasound, a machine that uses sound waves to create a picture of the node or abnormal tissue, to guide a needle to an abnormal lymph node and extract a tissue sample. The doctor will send this sample to a pathologist, who will examine it under a microscope and make a diagnosis based on what the cells look like in addition to doing special stains on the biopsy.  If material removed from the patient is not adequate or not completely clear, and the doctor still suspects non-Hodgkin lymphoma, he or she will most likely recommend an incisional or excisional biopsy. After diagnosis, the doctor may recommend additional biopsies to check for cancer spread to other parts of the body.

Excisional/Incisional Lymph Node Biopsy

In this procedure, a surgeon removes either an entire swollen lymph node (excisional biopsy) or a small piece of it (incisional biopsy) and sends it to a lab to be examined under a microscope for signs of non-Hodgkin lymphoma. Either test is a reliable method of diagnosing non-Hodgkin lymphoma, and usually provides a large enough tissue sample for a pathologist to determine the specific type of disease.

Bone Marrow Aspiration & Biopsy

In this test, a doctor uses a thin needle to extract a sample of tissue from the hip bone, and sends it to a lab to be examined under a microscope. This procedure is not usually used to diagnose non-Hodgkin lymphoma, but can be when abnormal blood counts are noted on laboratory work.  It can also can be done to help to determine whether the cancer is present in the bone marrow, as well as the stage of the disease.

Immunophenotyping and Immunhistochemistry:

Diagnosing non-Hodgkin lymphoma can be difficult and sometimes examination of the cells under a microscope is not enough to provide a definitive diagnosis. The pathologist may use special stains to identify certain proteins found in different types of non-Hodgkin lymphomas to help classify the lymphoma, and to establish what type it may be.

Molecular testing and next generation sequencing are other tests that might be used to further define the subtype of lymphoma.

Blood Tests

The doctor may recommend blood tests, including a complete blood count (CBC) with diferential to determine the levels of white and red blood cells and platelets in the blood, and a blood chemistry profile to monitor protein levels, liver function, and kidney function and electrolytes. Lactate dehydrogenase (LDH) is a blood test that may be used, along with a number of other patient and disease factors, to determine prognostic indexes and also may be used to follow disease response to treatment: however this is not a marker of lymphoma and can be elevated for other reasons. These tests are not used to diagnose the disease, but are useful in  different ways including in prognostic factors, monitoring the disease,  monitoring the side effects of chemotherapy and monitoring recovery.

Echocardiogram or MUGA

Certain chemotherapy drugs used to treat lymphoma can cause heart damage. An ultrasound of the heart is called an echocardiogram. Ultrasounds bounce sound waves off of your internal organs in order to create echoes that form a picture. The doctor may recommend regular echocardiograms while on these medications to monitor the size and function of the heart.

Computed Tomography (CT) Scan

A computed tomography (CT) scan uses X-rays to produce an image of your body. A special dye may be injected into your veins and you may be asked to drink a special fluid in order to make the internal organs stand out. It produces detailed cross-sectional images of the body, allowing doctors who read these scans to pinpoint the exact location of the cancer and check for involvement of organs.

Magnetic Resonance Imaging (MRI) Scan

MRI scans use radio waves and a strong magnet to create clear and detailed images of body parts. Radio waves are absorbed by the body and then released in a certain pattern, which is translated by a computer in order to show "slices" of the body. Doctors use MRIs to assess involvement in some organs, especially the brain and spinal cord, and sometimes the bones.

Positron Emission Tomography (PET) Scan

Doctors use PET scans for various reasons: sometimes the lymphoma may involve areas that are not easily seen on a CT scan and a PET scan can more accurately show areas of involvement, particularly in more aggressive lymphomas.  Often a PET is obtained after therapy is completed, and when the PET no longer shows involvement, the patient is considered to have a complete response which is often also referred to as being "in remission". The picture on a PET is not as detailed as one from a CT or MRI scan, but can show the whole body and help spot areas of involvement by lymphoma.  Although PET scans can be helpful they are not specific to only showing cancer and can have false positive results with infection and inflammation. Often a PET/CT is done which combine images.

Lumbar Puncture

Also known as a spinal tap, this is a test where doctors may sample spinal fluid to ensure there is no involvement of lymphoma in this fluid. This is done only for patients with more aggressive lymphomas and often patients will receive some specialized treatment this way.