What tests are performed to diagnose suspected lymphoma?

Lymphoma is highly prevalent in daily life. Numerous factors contribute to its development, severely compromising patients’ health and causing significant suffering. A hallmark symptom is painless lymph node enlargement. The disease may infiltrate multiple organs and tissues—including bone, skin, and the gastrointestinal tract—resulting in corresponding organ damage. So, what diagnostic tests should be performed when lymphoma is suspected? Let’s explore this together.

Diagnostic Tests for Suspected Lymphoma

First, a complete blood count (CBC) and peripheral blood smear examination are recommended. While the CBC may appear normal, chronic anemia is commonly observed. In Hodgkin lymphoma (HL), thrombocytosis, leukocytosis, and eosinophilia may occur. In non-Hodgkin lymphoma (NHL) with bone marrow involvement, patients may present with anemia, leukopenia, and thrombocytopenia; lymphoma cells may also be detected in the peripheral blood.

Second, bone marrow aspiration and biopsy are essential. Bone marrow involvement is rare in HL but occurs more frequently in NHL. In affected cases, bone marrow smears may reveal lymphoma cells characterized by large size, abundant chromatin, gray-blue cytoplasm, marked morphological abnormalities—including “tail-like” protrusions—and ≥20% lymphoma cells indicate lymphoblastic leukemia. Bone marrow biopsy typically demonstrates focal or diffuse infiltration by lymphoma cells. Additionally, some patients—particularly those with T-cell lymphoma—may exhibit hemophagocytosis and increased hemophagocytic cells on bone marrow smears.

Third, serum biochemical testing is indicated. Elevated lactate dehydrogenase (LDH) levels correlate with tumor burden. In HL, accelerated erythrocyte sedimentation rate (ESR) and elevated alkaline phosphatase may also be observed as adverse prognostic indicators.

Fourth, histopathological examination is critical. In HL, the characteristic finding is the presence of diagnostic Reed-Sternberg (R-S) cells and their variants against a background of mixed reactive inflammatory cells. Further molecular testing—including T-cell receptor (TCR) gene rearrangement analysis for T-cell lymphomas or immunoglobulin (Ig) gene rearrangement analysis for B-cell lymphomas—can aid diagnosis and differential diagnosis. Normal human peripheral B and T lymphocytes possess antigen receptor genes encoding the amino acid sequences of immunoglobulin or TCR polypeptide chains; clonal rearrangements detected via polymerase chain reaction (PCR) provide strong evidence for lymphoid malignancy.

We hope the above information is helpful to you.