The diagnosis of FL follows a similar workup for diagnosing other types of Non-Hodgkin’s Lymphoma (NHL).1
Diagnosis of NHL begins with a thorough history:
- Evaluation of symptoms — onset, behavior, presence of B-cell symptoms (fever, night sweats, weight loss)2
- Review of systems, noting any recent changes, infections1
- Quantifying performance status1
- Determining risk factors for NHL2
NCCN Clinical Practice Guidelines In Oncology (NCCN Guidelines®) for B-Cell Lymphomas provides diagnostic recommendations for FL.
|Physical Examination||The essential workup for FL includes a physical exam with particular attention to node-bearing areas.1|
|Laboratory Workup||Certain laboratory studies are essential in patients suspected of having follicular lymphoma. Additional studies may be informative in specific clinical situations, depending on history and physical exam findings.1|
|Immunophenotyping is required to establish a diagnosis of follicular lymphoma. Cytogenetic analyses and molecular genotyping may be useful for identifying translocations and mutations characteristic of follicular lymphoma.1|
|NHL is complex, requiring physicians to differentiate among many different subtypes.3 Biopsies can be used to help identify follicular lymphoma and are required to document clinical stage.1|
|Imaging Studies||Imaging is essential for diagnosis and staging of follicular lymphoma.1|
Below are characteristics of FL, as defined by the WHO 2016 classification system of FL:
WHO subtype classification of FL4-6
|Morphology||Immunophenotype||Cytogenetics||Molecular biology||Clinical features*|
|Centrocytes and centroblasts of germinal center origin||
|Morphology||Centrocytes and centroblasts of germinal center origin|
*Consistent with low-grade, indolent FL and may not necessarily be accurate for aggressive forms.
iNHL, indolent non-Hodgkin’s lymphoma; NCCN, National Comprehensive Cancer Network; WHO, World Health Organization.