Tests > Diagnostic Tests
Last Update: 02/28/2008
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Biopsy |
Biopsy
NOTE:
Best to avoid blood thinners prior to having a surgical
procedures, such as aspirin, fish oil, Vitamin E.
Talk to your doctor about medications and supplements you are taking.
IMPORTANT:
"If sufficient material is available, it is advantageous to snap
freeze a small portion of the lymph node in liquid nitrogen.
Frozen section immunohistochemistry and DNA gene rearrangement studies
can be performed on this material." - Bccancer
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 TOPIC
SEARCH:
Medscape | Web
| PubMed
- Core Biopsies
A
biopsy of suspected lymphoma
tissue (typically a lymph node), and subsequent evaluation
by a trained pathologist is the only way to
definitively diagnose lymphoma. It may take a week or
more to get the results,
and this time of waiting often causes considerable anxiety for patient and family. The
delay is not an indication that a lymphoma was found.
When surgical resection
(removal) of a lymph node is not possible, a Fine
Needle Aspiration or Large
Needle/Core Biopsy may be performed, but each of these
procedures have diagnostic limitations. Of the the two, an
image-guided core biopsy is more reliable.
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The Biopsy Report: A Patient's Guide - By Edward O.
Uthman, MD. Diplomate, American Board of Pathology Biopsy
Terms
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Recommendations for the Reporting of Lymphoid Neoplasms
Medscape (free login req.)
A checklist for pathologists and surgeons on how to evaluate and store lymphoid tissue at biopsy.
Why do we need to have this handy? When we ask informed questions, we are more likely
to get informed care. Note that it also includes guidance on how to snap
freeze the tissue.
Core Biopsy - Image Guided
| Effectiveness and Safety of Image-Directed Biopsies
Medscape
(free login req.)
from Southern Medical Journal
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| Clinical
utility of computed tomography-guided core needle biopsy in the
diagnostic re-evaluation of patients with lymphoproliferative
disorders and suspected disease progression. Ann Oncol. 2003
Sep;14(9):1438-41. PMID:
12954585
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Fine Needle Aspiration (FNA)
| Value and limitations of fine-needle aspiration
cytology in diagnosis and classification of lymphomas: A review. Diagn
Cytopathol. 1999 Oct;21(4):240-9. Review. PMID:
10495316 | Related
articles
Lymphomas have successfully been classified by FNA cytology
following the prevalent histologic classifications. The success rate
of FNA cytology ranges from 80%-90% in diagnosis of NHL and from
67.5%-86% in its subtyping.
The cytodiagnosis of Hodgkin's disease (HD) depends upon demonstration
of Reed-Sternberg cells or Hodgkin's cells amongst appropriate
reactive cell components. The diagnostic accuracy of FNA cytology for
HD has also been invariably high (>85%). Yet, the role of cytology
in primary diagnosis, subclassification and management of patients
with lymphoma remains controversial. The differential diagnostic
problems for NHL include a group of small round cell tumors,
nonlymphoid acute leukemias and HD.
Reservations have been expressed regarding the efficacy of cytology in
separating florid reactive hyperplasia from low-grade malignant
lymphoma.
The reported cytodiagnostic accuracy for follicular lymphomas and
nodular sclerosis type of HD is less compared to other subtypes of NHL
and HD respectively since nodular pattern and sclerosis are strict
histologic criteria which can not be appreciated in cytologic
preparations. Entities like atypical lymphoproliferative disorders,
peripheral T-cell lymphomas and Ki-1 positive anaplastic large cell
lymphomas pose diagnostic challenges to cytologists.
Despite these limitations, FNA cytology remains the first line of
investigations (screening test) used in cases of lymphadenopathy.
Besides initial diagnosis of lymphoma, it helps in detection of
residual disease, recurrences and progression of low-grade to
high-grade lymphoma, and helps in staging the disease.
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| About Fine Needle Aspiration and Large
Needle/Core Biopsy OncologyChannel
"because of small sample sizes and lack of information
about lymph node structure, FNA often is inadequate for the
initial diagnosis of HD or NHL. In such cases, larger tissue
samples are obtained by surgical biopsy." OncologyChannel
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| Fine-Needle Aspiration in Non-Hodgkin Lymphoma:
Evaluation of Cell Size by Cytomorphology and Flow Cytometry from
American Journal of Clinical Pathology - Posted 08/06/2002 Medscape
free login req.
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Image-guided core-needle biopsy (IGNB)
Image-guided
core-needle biopsy in patients with suspected or recurrent lymphomas
Abstract
BACKGROUND
It is now commonly admitted that the diagnosis of recurrence of lymphoma
can be assessed by image-guided needle biopsy (IGNB). However, the means
of obtaining tissue for the original diagnosis of lymphoma is often
surgery. The aim of this study was to compare the accuracy of IGNB at the
time of diagnosis and at the time of recurrence or progression.
METHODS
The authors performed 212 IGNBs on 194 patients who eventually had a
diagnosis of lymphoma. One hundred three IGNBs were obtained at original
diagnosis and 109 at recurrence or progression. Large-cutting core-biopsy
needles, ranging in size from 20 gauge to 14 gauge, were used.
Immunohistochemistry studies were performed in all lymphoma cases.
RESULTS
A diagnosis of lymphoma with subtyping was obtained in 88% of all cases,
in 85% at initial diagnosis, and in 89% at follow-up. Therapy was
initiated on the basis of IGNB in 93% of all cases, in 91% at initial
diagnosis, and in 94% at follow-up. Benign complications occurred in 7.5%
of cases and did not require specific treatment. IGNB was equally
effective for making a specific diagnosis of lymphoma and initiating
therapy at the time of original diagnosis and at follow-up.
CONCLUSIONS
The authors recommend that IGNB be performed as the initial procedure for
the diagnosis of lymphoma in the absence of peripheral lymph nodes, either
at presentation or at recurrence. Cancer 2000;89:647-52.
Also see:
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Bone
Marrow Biopsy |
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Moved to new
page |
DiSC
assay (optional)
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Differential
Staining Cytotoxicity (DiSC) may be useful to determine what
treatment agents will not work on your particular tumor cells.
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Flow
cytometry |
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Flow Cytometry Helps to identify the type of
lymphoma
An analogy might help.
Like people, lymphocytes have a life
span which includes stages of maturation where the appearance changes
as do the behaviors and roles in the body as the cells mature.
The type of cell and it's level of
maturation is identified by markers - called clusters of
differentiation (CD), similar to how people develop features at
different ages, (breasts, gray hair, etc)
Specific groups of markers help distinguish
between close cousin lymphocytes (follicular, Marginal zone, t-cell,
mantle cell, diffuse large b-cell, Hodgkins ...)
The cells are so very small (one
billion in a 1 cm lesion) that these differentiation markers
cannot be distinguished under a microscope but by "seeing"
which fluorescently tagged antibodies
stick to the cells.
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TOPIC
SEARCH: Medscape
Flow cytometry is a way of
"measuring the number of cells in a sample, the percentage of
live cells in a sample, and certain characteristics of cells, such as
size, shape, and the presence of tumor markers (such as Clusters of
Differentiation - CD) on the cell surface."
NCI
"By virtue of its ability to
evaluate not only surface but also cytoplasmic and nuclear antigens,
flow cytometry continues to enjoy widespread use in various capacities
in lymphoma evaluation and treatment. Additional roles for flow
cytometry are likely to be invented in the future and should provide
distinctive uses in the molecular era." 4
"It's performed on cells in liquid suspension (i.e. blood, bone
marrow, body fluids or tissue cell suspensions) that have been
incubated with fluorescently tagged antibodies directed against
specific cell surface proteins." ~ Univ. of Washington.
It is "a highly
complex process utilized by clinical laboratories to examine blood,
body fluids, bone marrow, and tissues. The technology of flow
cytometry and the discovery of a method to produce monoclonal
antibodies have made possible the clinical use of flow cytometry for
the identification of cell populations. This technique measures
multiple characteristics within the cell nucleus or cytoplasm (e.g.,
cell size, internal structure, antigens, DNA, ploidy, and cell cycle
analysis) that help distinguish one cell type from another." hgsa.com
Flow Cytometry Procedure Manual (Specimen
Collections) cancer.gov
Flow cytometry in lymphoma diagnosis and
prognosis: useful?
Best Pract Res Clin Haematol. 2003 Dec;16(4):583-97. PMID:
14592644
Flow cytometric analysis of lymphomas: current
status and usefulness.
Arch Pathol Lab Med. 2006 Dec;130(12):1850-8. Review. PMID:
17149963
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FISH |
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TOPIC
SEARCH: Medscape
Interphase fluorescence in situ
hybridization (FISH) is an alternative to conventional chromosome
analysis of chronic lymphocytic leukemia (CLL) cells.2
The FISH panel is performed for CLL
prognosis-specific genomic abnormalities as follows: ATM, Rb-1,
D13S25, Trisomy 12, p53 1
Chromosome Analysis, Chronic Lymphocytic
Leukemia (CLL) Panel by FISH aruplab.com
Chronic Lymphocytic Leukemia FISH Panel: Impact
on Diagnosis Medscape
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Histology |
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Some terms
Antigens - that which is capable of inducing a specific immune response
Morphology - appearance and structure
of cells
Autolysis - spontaneous rupture of
cell membrane
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Histology
Histology is the study of cells and tissue on the microscopic level.
Procedures and tests that follow are conducted on
tissue obtained from a biopsy.
Frozen Sections
Provides for a rapid provisional diagnosis and the
identification of antigens and or enzymes which maybe lost during
subsequent fixation and processing schedules. See source for
details.
Specimen Fixation
Preserve the tissue and cells without without
distorting or dissolving cellular constituents.
Paraffin Sections
Paraffin embedded tissue are cut to a thickness of
3µm. Sections are floated on a warm water bath, then picked up onto
microscope slides and allowed to drain. Sections for staining are
prepared. See source for details:
Resin Sections
Embedding tissues in resin offers several advantages
over frozen or paraffin sections, such as improved morphology and
less shrinkage.
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Immunocytochemistry
and Immunophenotyping |
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Some terms
Antigens - that which is capable of inducing a specific immune response
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Immunocytochemistry
The demonstration of antigens in tissue sections or smears by the
use of specific immunological (antibody-antigen) interactions
culminating in the attachment of a visible marker to the antigen. See
source for details.
Source: hmds.org Immunophenotyping
Tests that reveal the kinds of
surface molecules that are present on cells (typically immune cells),
such as CD20, CD22.
CD stand for clusters of
differentiation, which show the developmental stage of the cell and
the cell type. CD20, for example, is expressed only on mature
b-cells, but not t-cells.
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Lumbar
puncture
(not common) |
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Checks for
malignant cells in the
cerebrospinal fluid (CSF), which circulates around the brain and spinal cord.
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Mediastinoscopy
(not common) |
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"The
mediastinumis is the space that
separates the 2 lungs and contains the heart, thymus, esophagus,
trachea, the large blood vessels, and lymph nodes. A mediastinoscopy
is a procedure in which a lighted instrument (mediastinoscope) is
inserted through a neck incision to visually examine the structures in
the top of the chest cavity." MedlinePlus
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Molecular
Diagnostics - LymphoChip |
"Ultimately, this effort will guide patients towards
therapies that are tailored for their particular diseases and will
identify new molecular targets for therapeutic development."
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"We
began a study of gene expression in lymphoid malignancies by
constructing a specialized DNA microarray, termed the "Lymphochip",
that is enriched in genes which are selectively expressed in
lymphocytes and genes which regulate lymphocyte function (1)."
Source: Full
text: nih.gov The
LymphoChip promises to:
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help identify new molecular targets
for treatment. |
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predict clinical response to
therapy and long-term outcome. |
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generate gene expression profiles
of lymphoma and leukemia. |
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help correlate response to
treatment with gene expression and thus better match patient to
treatment in the future. |
| show how treatment affects gene
expression. |
LINKS
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Application of tissue microarray technology to
the study of non-Hodgkin's and Hodgkin's lymphoma. Hum Pathol.
2002 Oct;33(10):968-974. PMID: 12395368 - PubMed
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Molecular Diagnostics
Rita M. Braziel, Margaret A. Shipp, Andrew L. Feldman, Virginia
Espina, Mary Winters, Elaine S. Jaffe, Emanuel F. Petricoin III and Lance A. Liotta
asheducationbook.org
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Molecular Profiling: Anticipate Clinical
Application in Cancer Patients ASCO
News
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PCR |
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PCR
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Polymerase Chain Reaction (PCR) analyses can be used to detect
small amounts of lymphoma cells in the bone marrow and
peripheral blood of patients with lymphoma.
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Detection of occult lymphoma in the peripheral blood and bone
marrow of patients with untreated early-stage and advanced-stage
follicular lymphoma
NL Berinstein, MD Reis, BY Ngan, CA Sawka, HH Jamal and B Kuzniar
Department of Medicine, Immunology, University of Toronto,
Ontario, Canada.
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Splenectomy |
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"Splenectomy, with an
acceptable surgical risk, has the potential to establish the diagnosis
of NHL in patients with splenomegaly (enlargement of the spleen)
without lymphadenopathy (enlarged lymph nodes) and negative bone
marrow findings.
Moreover, splenectomy has the capacity to modify the
disease course in patients with NHL complicated by AIHA or
hypersplenism."
Source: Splenectomy in patients with malignant
non-Hodgkin's lymphoma. Eur J Haematol. 2000 Mar;64(3):145-50. PMID:
10997879 PubMed |
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