B-cell lymphoma diagnostic study of choice

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Adnan Ezici, M.D[2]

B-cell lymphomas include both Hodgkin’s lymphomas and most Non-Hodgkin lymphomas. Excisional lymph node biopsy is the gold standard test for the diagnosis of B-cell lymphomas. It is the preferred method to protect the architecture of lymph nodes, which is crucial for pathological evaluation and classification of lymphoma.

B-cell lymphomas include both Hodgkin’s lymphomas and most Non-Hodgkin lymphomas.

• Excisional lymph node biopsy is the gold standard test for the diagnosis of B-cell lymphomas. It is the preferred method to protect the architecture of lymph nodes, which is crucial for pathological evaluation and classification of lymphoma.^[1][2][3][4]
• Fine-needle aspiration or core-needle biopsy specimens are usually insufficient because these methods have a low ratio of malignant cells and they do not sufficiently preserve the architecture of lymph nodes.
• Diagnostic studies of B-cell lymphomas include light microscopic evaluation of pathologic sample, as well as an immunophenotypic analysis with immunohistochemistry to determine the subtype.

• The following findings on pathological evaluation are confirmatory for Hodgkin’s lypmhoma:^[4]
  • Reed-Sternberg cells (RS)
  • Lymphocyte predominant cells (LP)
• The following findings on immunophenotypic analysis are confirmatory for the following types of non-Hodgkin’s lypmhoma:^[5][2]
  • MYC-IGH rearrangement detected by FISH in the presence of a BCL2 negative germinal centres phenotype is definitive for diagnosis of Burkitt lymphoma.
  • A disrupted structure of follicle center by sheets of large cells which are positive for pan-B-cell antigens (e.g., CD20, CD79a) is definitive for diagnosis of diffuse large B-cell lymphoma (DLBCL).^[6]
  • A chromosomal translocation t(11:14) is definitive for diagnosis of mantle cell lymphoma.^[7]