Different tests are used to diagnose lymphoma, to know how much lymphoma is in the body (called ‘staging’), to help doctors assess how well different treatments might work, and to measure if treatments are working.
Biopsy
To obtain a sample of the lymphoma for testing, some of the cancer is removed through an incision or by using a special type of needle. The sample is sent to a specialised laboratory with expertise in lymphoma.
Blood Tests
Used to check overall health, blood cell counts, investigate other medical conditions, and how well kidneys and liver are functioning. These can include:
- Complete blood count (CBC) with differential: A measure of the number of white blood cells, red blood cells, and platelets in the blood, including the different types of white blood cells (neutrophils, lymphocytes, monocytes, basophils, and eosinophils). It is useful for diagnosing and monitoring many conditions.
- Comprehensive metabolic panel (CMP): A series of blood tests that measure different substances in the blood. These tests provide important information about the body’s chemical balances and metabolism and are often used to help monitor or diagnose certain health conditions.
- Lactate dehydrogenase (LDH) test: LDH is an enzyme found in most of the body’s tissues that is involved in making energy. If the tissues are damaged or diseased, LDH is released into bodily fluids, including blood. A high LDH means there is tissue damage.
Scans
There are many different types of imaging technologies that look at the interior of a body. Each works differently. These can include:
- Computed tomography (CT) scan: A diagnostic imaging test that creates a computer-generated 3D image of the body using a series of rotating X-ray machines. Unlike regular X-rays, this scan shows tissue, blood vessels and bones.
- Magnetic resonance imaging (MRI): Creates detailed images of nearly every structure and organ inside the body. It uses strong magnets and radio waves to create 3D pictures of the different tissue types.
- Positron emission tomography (PET) scan: A procedure where a small amount of radioactive glucose (sugar) is injected into a vein, and then a scanner is used to make computerised pictures of areas inside the body where the glucose is absorbed. A PET scan can be used to find cancer cells in the body because they take up more glucose than normal cells.
- Deauville score: A five-point scale that is based on visual interpretation of FDG (fluorodeoxyglucose) uptake in a patient as seen through a PET or CT scan. The scale ranges from 1 to 5, where 1 is best (no uptake or no residual uptake) and 5 is worst (significant increase in uptake or any new lesion).
Heart Function (Cardiac Assessment)
Used to see how well the heart is working. This can include:
- Electrocardiogram: A quick test to measure heart rhythms.
- Echocardiogram (ultrasound): Used to see images of the heart as it beats.
- Multigated acquisition (MUGA) scan: Evaluates how your heart pumps blood. It uses an injection of a substance called radionuclide and a specialized camera. As the radionuclide travels through the blood, pictures are taken of the heart. A MUGA scan measures how your heart muscle contracts and relaxes while you rest or exercise.
- Blood pressure measurement: Used to assess the force of blood against the walls of your arteries.
Eastern Cooperative Oncology Group (ECOG) Performance Status:
This non-invasive test evaluates the
patient’s ability to care for themself, perform daily activities, and their physical ability. The score ranges from 0 to 5, with 0 indicating fully active and 5 indicating death. A score of 2 or higher indicates increasing disability.
Physical Exam
Includes temperature, blood pressure, pulse, breathing rate, height, weight, touching to see if parts of your body and organs are of normal size, are soft or hard, or sensitive to touch, and looking for signs of lymphoma (for instance, enlarged lymph nodes in the neck, underarm, and groin) or infection.
Lab-based tests
Used to diagnose lymphoma and the correct subtype, as well as looking at molecular or genetic changes that can impact the type of treatment a patient receives.
- Flow cytometry: Flow cytometry means cell (‘cyto’) measurement (‘metry’) in a fluid stream (‘flow’). This test looks at blood cells, marrow cells or cells from a biopsy. Flow cytometry measures the number of cells in a sample, how fast the cell is dividing, and it can determine cell features such as size, shape, and presence of tumour markers. Cells are stained with a dye that is light-sensitive, placed in a fluid, and then passed one at a time through a light beam. Measurements are taken based on how the cells react to the light beam.
- Fluorescence in situ hybridization (FISH): FISH is a test that examines the genes or chromosomes in cells and tissues. It is used to identify genetic mutations and abnormalities. To perform this test, pieces of DNA containing a fluorescent dye are added to the patient’s cells or tissues on a glass slide. When these pieces of DNA bind to specific genes or areas of chromosomes on the slide, they light up when viewed under a microscope with a special light.
- Immunohistochemistry (IHC): Immunohistochemistry means the composition and properties (‘chemistry’) of immune (‘immuno’) tissue (‘histo’). IHC uses antibodies to test for certain markers, also called antigens, which are on or in a cell.
- Immunophenotyping: Immunophenotyping is a process used to determine immune (‘immuno’) cells observable (‘pheno’) appearance (type). Immunophenotyping is used to diagnose certain leukaemia and lymphoma. This test uses antibodies to identify cells based on the types of antigens or markers on the cell’s surface.
- Molecular risk assessment: A procedure in which biomarkers are used to estimate a person’s risk for developing cancer. Specific biomarkers may be linked to particular types of cancer.
- Molecular profiling / genetic markers / genetic profiling / driver gene-based classification: The science of identifying disease through DNA, genes, chromosomal translocations and mutations. These are sometimes done using a lymphoma specimen and sometimes using a blood sample.
- Next generation sequencing (NGS): A DNA sequencing technology. With NGS, the human genome can be sequenced in one day. This is much faster than previously available technology.
- Polymerase chain reaction (PCR) test: A lab test that can produce many copies of a DNA segment for study.
Other tests as needed
Additional procedures and assessments may be used to support diagnosis, evaluate overall health, and guide treatment decisions. These can include:
- Endoscopy: A procedure to examine the interior of an organ in the body. There are many types of endoscopies. Most often, the term endoscopy is used to refer to an examination of the upper part of the gastrointestinal tract.
- Fertility assessments: For those who wish to have biological children after treatment, additional tests and procedures may be done to assess and preserve fertility.
- Geriatric assessment: A special series of tests to see how well older people are functioning physically, mentally, and emotionally, all of which naturally decline as people age.
- Lumbar puncture: A special type of needle is inserted into the lower spine to withdraw fluid (called cerebrospinal fluid). This procedure is sometimes called a spinal tap. This can be done to check to see if the cancer has spread to the central nervous system.