Here I am discussing diagnostic tests and staging of non-Hodgkin’s disease, which is also known as non-Hodgkin’s lymphoma.
Tests
The diagnosis is done most directly by biopsy of affected lymph nodes. Immunophenotyping is also very helpful.
This is a method, which determines through the use of monoclonal antibodies, which surface antigens the leukemia cell is carrying. A certain constellation of markers is typical and very specific for a non- Hodgkin’s lymphoma.
A different constellation is typical for Hodgkin’s lymphoma. Some of the more rare forms of these lymphomas can be classified by using these tumor markers.
Staging of Non-Hodgkin’s Lymphoma
As with Hodgkin’s disease, so also with non- Hodgkin’s disease, also known as non- Hodgkin’s lymphoma (NHL), the Ann Arbor staging system is used to assess the extent of the disease prior to treatment. This needs to be somewhat modified as the subtypes of NHL do not only have a different prognosis according to the spread of the NHL, but also according to the cell type that is present.
Diagnostic Tests / Staging Of Non-Hodgkin’s Disease
The International Non-Hodgkin’s Prognostic Index divides the NHL into low-grade lymphomas, intermediate-grade lymphomas and high-grade lymphomas. This is based on risk group analysis. The following table is a simplified version of an article in the New England Journal of Medicine (Ref.1):
Outcome according to risk group (International Prognostic Index)
| NHL risk group: | Remission rate: | 2-year survival: | 5-year survival: |
| low-grade | 90% | 80% | 70% |
| intermediate | 60% | 60% | 45% |
| high-grade | 45% | 35% | 25% |
References:
1. N Engl J Med 329(14):987-994,1997.
2. The Merck Manual of Diagnosis and Therapy. 17th edition, editors M.Beers and R.Berkow. Whitehouse Station, N.J., 1999.
3. Cancer: Principles & Practice of Oncology. 4th edition, edited by V.T. DeVita et al., Lippincott Co., Philadelphia, 1993. Chapters 51 and 52.
4. Cancer: Principles&Practice of Oncology. 5th edition, volume 2. Edited by Vincent T. DeVita, Jr. et al. Lippincott-Raven Publ., Philadelphia,PA, 1997. Chapter 44,Lymphomas.
5. HY Dong et al. Mod Pathol 2001 May;14(5):472-481.
6. NL Kobrinsky et al. J Clin Oncol 2001 May 1;19(9):2390-2396.
7. Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier
8. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc
