Excisional biopsy is
preferred for diagnosis, although core-needle biopsy may suffice
when not feasible.
Clinical evaluation includes
careful history, relevant laboratory tests, and recording of
PET-CT is the standard for
FDG-avid lymphomas, whereas CT is indicated for nonavid
histologies.A modified Ann Arbor staging system is recommended;
however, patients are treated according to prognostic and risk
factors. Suffixes A and B are only required for HL.
The designation X for bulky
disease is no longer necessary; instead, a recording of the
largest tumor diameter is required.
If a PET-CT is performed, a
BMB is no longer indicated for HL;
a BMB is only needed for DLBCL if the PET is negative and
identifying a discordant histology is important for patient
The data in all other lymphoma histologies are insufficient to
change the standard practice, and a 2.5-cm unilateral BMB is
recommended, along with immunohistochemistry and flow cytometry.
in patients who achieve complete remission after
initial therapy for lymphoma
* asco.org: Surveillance Imaging for Lymphoma: Pros and Cons
Lynch, Zelenetz, Armitage, Carson
Although there is no overwhelming evidence discouraging the
practice of surveillance imaging, there is also insufficient data
supporting it. Review of the studies in Table 1 demonstrates the low
number of asymptomatic relapses detected by surveillance imaging in
patients with aggressive NHL and HL, the low positive-predictive
value of abnormalities detected by imaging, and no demonstration of
a survival benefit.
Although it is possible that some patients may benefıt from
surveillance imaging, at this time the uncertainty surrounding the
estimates of risks and benefıts does not allow for reasonable
estimation of the risk-benefıt ratio. When the absence of
demonstrable benefits is considered in conjunction with the possible
harm, a cautious approach to surveillance imaging is warranted.
* From JNCCN: Role of Routine Imaging in Lymphoma
Nina D. Wagner-Johnston, MD; Nancy L.
registration and login required)
10 part discussion, copying here the conclusion:
Available data do
not convincingly show a therapeutic advantage for routine imaging in
patients with lymphoma. Surveillance CT and PET/CT yield a low rate
of detection of recurrence, and suspected relapses are frequently
not confirmed, leading to needless downstream testing and patient
anxiety because of false-positive results.
When considering cost-effectiveness and increased risk secondary to
radiation exposure, current imaging guidelines must be questioned.
The small number of events detected from the mostly retrospective
series precludes an overall assessment of whether early detection of
relapse may impact outcome. Analyzing large databases may address
these concerns. Ultimately, randomized studies are needed to answer
questions regarding the role of routine imaging in lymphoma. A
national surveillance study comparing routine imaging versus routine
care without imaging, similar to those conducted in breast cancer,
is justified and would be an excellent expenditure of resources.
See also About Long Term Risks of CT
First, it's important to note that cautions
about risks of a secondary cancer from CT is generally aimed at
the general public and in particular younger people who may
receive CT imaging without a clear cut medical necessity to do
so. ... CT imaging - long term