Guidelines on Diagnosis and Treatment of Malignant Lymphomas

Classification system
The World Health Organization (WHO) classification of
neoplastic diseasesTumours of the haematopoietic and lymphoid
tissues, 4th edition 2008 should be used.
Diagnostic requirements for
haematopathology diagnosis
The diagnosis of lymphoma should be made, or reviewed, in a
laboratory with the necessary specialist expertise and facilities.
A pathology laboratory diagnosing lymphoma requires access to
the following resources:
a. Morphological expertise: Pathologists/haematologists
involved in lymphoma diagnosis should have the necessary
training to undertake this work.
b. Immunophenotyping: All marker studies should be
carried out using panels designed to test the validity of the
morphological diagnosis and to demonstrate key prognostic
variables. Marker studies should be carried out using flow
cytometry and immunohistochemistry. An appropriate panel
for the lymphoma sub-types is included in the lymphomaspecific
sections in this document.
c. Molecular techniques: The two main techniques are
polymerase chain reaction (PCR) to detect monoclonality
and some translocations, and fluorescence in situ
hybridisation (FISH) techniques for translocations.
These techniques should be used to confirm a provisional
diagnosis and identify prognostic factors. Formal links with
a molecular/cytogenetics service are required.
d. Integrated reporting: Most patients with
lymphoproliferative disorders have different specimens taken
during their clinical course. Departments should have a
mechanism for correlating results from lymph node biopsies,
bone marrow aspirates and biopsies as well as different
analyses of a single sample.
Reporting
A preliminary report should be available 5 working days after the
specimen is received. This interim report should state specific
outstanding investigations and be followed by a definitive report.
Quality assurance and audit
The main component of quality assurance is access to a robust
and timely diagnostic process. An audit system designed to test
the quality of the service should be in place. Laboratories should
be able to provide users of the laboratory with details of their
diagnostic criteria and technical methods.
Laboratories should participate in the relevant quality assurance
schemes for immunocytochemistry, flow cytometry and other
diagnostic methods. Individual histopathologists should have
access to a lymphoma review panel.
Diagnosis –
laboratory procedures and standards
■ Unfixed node biopsy imprint preparation –
formalin preparation of material, snap freezing and
disaggregation into single-cell suspension
■ WHO classification
■ Access to immunophenotyping, molecular
techniques and molecular genetic techniques
■ Preliminary report within 5 working days
■ Systems of quality assurance in place: Standard
Operating Procedures (SOPs); Lab Accreditation;
National Quality Assurance Scheme
■ Access to review panel
Multidisciplinary team (MDT) working
MDT meetings are a desirable part of the diagnosis and
management of lymphoma. The arrangements will vary with local
circumstances but it is essential that diagnostic pathology and
staging radiology be reviewed in both new and relapsed patients
before making a management plan. This plan should be clearly
documented in patients’ notes.
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