Laboratory Workup of Lymphoma in Adults
Publication Date: November 10, 2020
Last Updated: March 14, 2022
Recommendations
Clinical care providers should use surgical biopsy when feasible in a clinical setting where HL is highly suspected. (Low-quality evidence, Strong recommendation)
608
Clinical care providers should obtain excisional biopsy or CNB specimens in patients with high suspicion of lymphoma. (Moderate-quality evidence, Strong recommendation)
608
Clinical care providers should not use FNA cytomorphology alone without ancillary testing to achieve a definitive diagnosis of lymphoma. (Low-quality evidence, Strong recommendation)
Note: Cytomorphology alone without ancillary studies has low sensitivity and low predictive value.
Note: A defined subset of lymphoma requires architectural assessment and cannot be reliably diagnosed and subclassified by FNA.
608
Clinical care providers should follow up patients with negative results for persistent signs and symptoms of lymphoma and pursue larger-volume biopsy when clinical suspicion for lymphoma persists. (Moderate-quality evidence, Strong recommendation)
608
Clinical care providers may use positron emission tomography (PET) with 2-deoxy-2-[fluorine-18]fluoro-d-glucose (FDG) to identify sites for biopsy in patients with suspected transformed/aggressive-histology lymphoma. As feasible, biopsies should be directed to the site of greatest FDG avidity. (Low-quality evidence, Conditional recommendation)
608
Clinical care providers may obtain bone marrow biopsies for the primary diagnosis in select patients with suspected lymphomas. (Low-quality evidence, Conditional recommendation)
Note: For certain lymphoma types (eg, splenic low-grade lymphomas, lymphoplasmacytic lymphomas [LPLs]), bone marrow biopsy may be preferred to more invasive surgical methods.
608
Clinical care providers may use cerebrospinal fluid (CSF) for the evaluation of primary or secondary central nervous system (CNS) lymphoma in select patients. (Low-quality evidence, Conditional recommendation)
608
Clinical care providers should use a combined morphologic and flow cytometric evaluation of CSF in the investigation of possible primary or secondary CNS lymphoma in select patients. (Low-quality evidence, Strong recommendation)
608
Based on low NPVs, clinical care providers should follow up patients with negative results for persistent signs and symptoms of CNS lymphoma and pursue repeat CSF examination or biopsy when clinical suspicion for lymphoma persists. (Low-quality evidence, Strong recommendation)
608
Clinical care providers should use immunophenotyping by flow cytometry and/or IHC in addition to morphology for the evaluation of specimens for the diagnosis and subclassification of lymphomas. (Moderate-quality evidence, Strong recommendation)
608
Clinical care providers may use FISH analysis when evaluating specimens in patients with suspected or confirmed lymphoma, or in the subclassification of lymphoma. Fluorescence in situ hybridization analysis is feasible on specimens obtained by FNA and may increase diagnostic yield. (Low-quality evidence, Conditional recommendation)
Note: Demonstration of the appropriate rearrangements is required for a diagnosis of high-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements.
608
Clinical care providers should not routinely use up-front PCR-based clonality studies of antigen receptor genes (ie, TCR and immunoglobulin) in the initial investigation of lymphoma. There may be a confirmatory role in certain settings for these studies. (Low-quality evidence, Conditional recommendation)
608
Clinical care providers may use molecular tests to aid in classification of lymphomas. For example, pathologists may use MYD88 L265P to aid in the classification of indolent B-cell lymphoma. (Low-quality evidence, Conditional recommendation)
Note: This recommendation statement refers to non-FISH molecular tests.
608
Good Practice Statements
For the diagnosis of difficult-to-classify lymphomas, laboratories should have a robust peer review process. Peer review may include a second review by a more experienced pathologist or a consensus review by a group of pathologists. (, )
608
Pathologists should use clinical information in the workup and classification of lymphoma and lymphoma subtypes. (, )
608
Laboratorians should include specimen-handling elements in the final pathology report. (, )
608
Laboratories should provide appropriate turnaround times for lymphoma test results to inform clinical decision-making. (, )
608
Laboratories should establish policies to ensure efficient allocation and use of tissue for lymphoma testing. (, )
608
Laboratories that send out tests for lymphoma diagnosis should have a process in place to ensure that specimens are sent and reviewed by outside reference laboratories in a timely manner. (, )
608
Recommendation Grading
Overview
Title
Laboratory Workup of Lymphoma in Adults
Authoring Organizations
American Society for Clinical Pathology
College of American Pathologists
Publication Month/Year
November 10, 2020
Last Updated Month/Year
August 29, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Female, Male, Adult
Health Care Settings
Ambulatory, Hospital
Intended Users
Social worker, physician, nurse, nurse practitioner, physician assistant
Scope
Diagnosis, Management
Diseases/Conditions (MeSH)
D008223 - Lymphoma
Keywords
lymphoma, Laboratory workup
Source Citation
Kroft SH, Sever CE, Bagg A, Billman B, Diefenbach C, Dorfman DM, Finn WG, Gratzinger DA, Gregg PA, Leonard JP, Smith S, Souter L, Weiss RL, Ventura CB, Cheung MC. Laboratory Workup of Lymphoma in Adults: Guideline From the American Society for Clinical Pathology and the College of American Pathologists. Arch Pathol Lab Med. 2021 Mar 1;145(3):269-290. doi: 10.5858/arpa.2020-0261-SA. PMID: 33175094.
Supplemental Methodology Resources
Methodology
Number of Source Documents
97
Literature Search Start Date
December 31, 2006
Literature Search End Date
September 14, 2018