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==Overview==
==Overview==
According to the Ann Arbor staging system, there are four stages of non-Hodgkin lymphoma based on the number of nodes and extra nodal involvement.
The diagnostic study of choice for non-Hodgkin lymphoma is excisional lymph node biopsy. A bone marrow biopsy is an alternative to a lymph node biopsy.  
==Staging==
==Diagnostic study of choice==
According to the Ann Arbor staging system, there are four stages of non-Hodgkin lymphoma based on the number of nodes and extra nodal involvement.<ref name=CCN>{{cite web | title = Canadian Cancer Society Stages of non-Hodgkin lymphoma | url = http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/staging/?region=ab}}</ref>
*The diagnostic study of choice for non-Hodgkin's lymphoma is excisional lymph node biopsy. An excisional biopsy is needed because it preserves the architecture of the lymph node and allows for precise determination of the type of lymphoma. Fine needle aspiration biopsy is insufficient. In addition to light microscopy evaluation of the excisional biopsy samples, the immunophenotypic analysis with immunohistochemistry helps to determine non-Hodgkin's lymphoma subtypes and distinguish non-Hodgkin's lymphoma from T cell rich large B cell lymphoma and anaplastic large cell lymphoma. The presence of CD20 positive clonal B cells defines non-Hodgkin lymphoma. Flow cytometry is an effective method in differentiating between Hodgkin's lymphoma and non-Hodgkin lymphoma, as well as subtypes of non-Hodgkin lymphoma.
Staging for non-Hodgkin lymphoma is provided in the following table:
 
*A bone marrow biopsy can also be done to diagnose non-Hodgkin lymphoma if there is sufficient evidence of marrow involvement (i.e. presence of cytopenias). Non-Hodgkin lymphoma cells originate in the bone marrow, which is the site of B cell production and maturation. A length of 2cm of the core biopsy is generally needed for diagnosis, which is in contrast to diagnostic requirements for leukemias. A bone marrow is not the diagnostic study of choice for Hodgkin lymphoma if a lymph node can be biopsied.
 


{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+ '''Ann Arbor staging system'''
! style="background: #4479BA; color:#FFF;" | Stage
! style="background: #4479BA; color:#FFF;" | Involvement
|-
| style="padding: 5px 5px; background: #DCDCDC;" colspan=3 | '''stage I'''
|-
| style="padding: 5px 5px; background: #F5F5F5;" | I
| style="padding: 5px 5px; background: #F5F5F5;" | One nodal group or lymphoid organ (e.g. spleen or thymus)
|-
| style="padding: 5px 5px; background: #F5F5F5;" | IE
| style="padding: 5px 5px; background: #F5F5F5;" | One extra nodal site
|-
| style="padding: 5px 5px; background: #DCDCDC;" colspan=3 | '''stage II'''
|-
| style="padding: 5px 5px; background: #F5F5F5;" | II
| style="padding: 5px 5px; background: #F5F5F5;" | Two or more nodal groups, same side of diaphragm
|-
| style="padding: 5px 5px; background: #F5F5F5;" | II E
| style="padding: 5px 5px; background: #F5F5F5;" | Localized extra nodal site with stage II criteria, both on the same side of the diaphragm
|-
| style="padding: 5px 5px; background: #DCDCDC;" colspan=3 | '''stage III'''
|-
| style="padding: 5px 5px; background: #F5F5F5;" | III
| style="padding: 5px 5px; background: #F5F5F5;" | Nodal groups on both sides of the diaphragm
|-
| style="padding: 5px 5px; background: #F5F5F5;" | III S (1)
| style="padding: 5px 5px; background: #F5F5F5;" | With splenic involvement
|-
| style="padding: 5px 5px; background: #F5F5F5;" | III E (2)
| style="padding: 5px 5px; background: #F5F5F5;" | With localized extra nodal site
|-
| style="padding: 5px 5px; background: #F5F5F5;" | III SE
| style="padding: 5px 5px; background: #F5F5F5;" | Both
|-
| style="padding: 5px 5px; background: #DCDCDC;" colspan=3 | '''stage IV'''
|-
| style="padding: 5px 5px; background: #F5F5F5;" | IV
| style="padding: 5px 5px; background: #F5F5F5;" | Disseminated involvement of one or more extra lymphatic organ (e.g. lung, bone) +/- any nodal involvement
|-
| style="padding: 5px 5px; background: #DCDCDC;" colspan=3 | '''Additional staging variables'''
|-
| style="padding: 5px 5px; background: #F5F5F5;" | X
| style="padding: 5px 5px; background: #F5F5F5;" | Bulky nodal disease: largest tumor is 10 cm or larger
|-
| style="padding: 5px 5px; background: #F5F5F5;" | A
| style="padding: 5px 5px; background: #F5F5F5;" | Asymptomatic
|-
| style="padding: 5px 5px; background: #F5F5F5;" | B
| style="padding: 5px 5px; background: #F5F5F5;" | Presence of B symptoms ([[fever]], [[night sweats]] and [[weight loss]])
|-
| style="padding: 5px 5px; background: #F5F5F5;" | E
| style="padding: 5px 5px; background: #F5F5F5;" | Extra nodal: other than the lymph nodes or spread to tissues beyond, but nearby, the lymphatic tissues
|-
| style="padding: 5px 5px; background: #F5F5F5;" | S
| style="padding: 5px 5px; background: #F5F5F5;" | Spleen
|-
| style="padding: 5px 5px; background: #F5F5F5;" | Limited disease 
| style="padding: 5px 5px; background: #F5F5F5;" |
* Stage I or II<BR>
* No B symptoms<BR>
* Non-bulky tumor
|-
| style="padding: 5px 5px; background: #F5F5F5;" | Advanced disease 
| style="padding: 5px 5px; background: #F5F5F5;" |
* Stage III or IV<BR>
* B symptoms<BR>
* Bulky tumor
|}
==References==
==References==
{{reflist|2}}
{{reflist|2}}

Revision as of 04:52, 29 December 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2]; Associate Editor(s)-in-Chief: Sowminya Arikapudi, M.B,B.S. [3]

Overview

The diagnostic study of choice for non-Hodgkin lymphoma is excisional lymph node biopsy. A bone marrow biopsy is an alternative to a lymph node biopsy.

Diagnostic study of choice

  • The diagnostic study of choice for non-Hodgkin's lymphoma is excisional lymph node biopsy. An excisional biopsy is needed because it preserves the architecture of the lymph node and allows for precise determination of the type of lymphoma. Fine needle aspiration biopsy is insufficient. In addition to light microscopy evaluation of the excisional biopsy samples, the immunophenotypic analysis with immunohistochemistry helps to determine non-Hodgkin's lymphoma subtypes and distinguish non-Hodgkin's lymphoma from T cell rich large B cell lymphoma and anaplastic large cell lymphoma. The presence of CD20 positive clonal B cells defines non-Hodgkin lymphoma. Flow cytometry is an effective method in differentiating between Hodgkin's lymphoma and non-Hodgkin lymphoma, as well as subtypes of non-Hodgkin lymphoma.
  • A bone marrow biopsy can also be done to diagnose non-Hodgkin lymphoma if there is sufficient evidence of marrow involvement (i.e. presence of cytopenias). Non-Hodgkin lymphoma cells originate in the bone marrow, which is the site of B cell production and maturation. A length of 2cm of the core biopsy is generally needed for diagnosis, which is in contrast to diagnostic requirements for leukemias. A bone marrow is not the diagnostic study of choice for Hodgkin lymphoma if a lymph node can be biopsied.


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