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An accurate diagnosis is one of the most important aspects of a person’s care. A precise diagnosis will help the doctor to

  • Estimate the rate of disease progression
  • Determine the appropriate treatment.

Physical Evaluation

The doctor will take a comprehensive medical history and ask questions regarding either the absence or the presence of B symptoms. Physical examination will include measurement of all accessible lymph node groups, as well as the size of organs, such as the spleen and liver. 

Lymph Node Biopsy

A biopsy of an involved lymph node or other tumor site is needed to confirm the NHL diagnosis and subtype.  A needle biopsy may be done, but a needle usually cannot obtain a large enough specimen of lymph node tissue for the hematopathologist (a doctor who specializes in diagnosing diseases of the blood and marrow) to make a firm diagnosis. To ensure that there is enough tissue to make an accurate diagnosis, either a small area of tissue is taken (an incisional biopsy) or an entire lymph node is removed (an excisional biopsy). The decision which type of biopsy to use is based on the location of the tumor. The patient is usually given a local anesthetic.

The purpose of a lymph node biopsy is to:

  • Confirm a diagnosis
  • Identify your NHL subtype
  • Develop a treatment plan.

NHL can develop in parts of the body that do not involve lymph nodes, such as the lung or bone. When lymphoma is detected exclusively outside of the lymph nodes, it is called “primary extranodal lymphoma,” and the biopsy specimen is taken from that involved tissue.

Additional Tests

Additional tests that may be necessary include:

  • Immunophenotyping 
  • Flow cytometry
  • Fluorescence in situ hybridization (FISH)

Click here to read about these tests.

Getting a Second Opinion

NHL is a difficult disease to diagnose, therefore you may want to get a second opinion by an experienced hematopathologist before you begin treatment. Some types of NHL can be confused with one other. The appropriate treatment depends on having the correct diagnosis.

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