Biopsy and Histology

Lymph Node Biopsy

Excisional Lymph Node Biopsy

Excisional biopsy (entire lymph node removed) is recommended to establish the diagnosis of NHL1

  • Adequate tissue volume is essential1
    • Note: Core needle biopsy (large bore needle removes a core of lymph node tissue) is not recommended unless there is no other way to obtain the necessary diagnostic tissue1
    • The role of fine needle biopsy in the diagnosis of lymphoma is controversial; when used alone, there is often inadequate tissue for diagnostic tests1

Rationale for Tissue Biopsy

Complete and accurate differential diagnosis of FL and other NHL subtypes requires characterization of tumor morphology and molecular characteristics of the tumor cells.1 Biopsy tissue can be used for the following tests:

When to perform tissue biopsy

  • Initial diangosis1
  • Potentially at recurrence/relapse2

Bone Marrow Biopsy

Bone marrow aspiration and biopsy may be used to determine if there is bone marrow involvement in a patient1

  • Bone marrow biopsy plus aspiration should be performed at diagnosis and is essential to document clinical stage I-II FL1
  • If a patient has a low-burden indolent NHL that will undergo observation, bone marrow evaluation may be deferred1

Bone marrow involvement occurs in 70% of FL cases.3

References: 1. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for B-Cell Lymphomas V.4.2019. © National Comprehensive Cancer Network, Inc. 2019. All rights reserved. Accessed July 10, 2019. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way. 2. Pulla MP, Lizaso JA, de la Cruz Merino L, et al. SEOM clinical guidelines for the treatment of follicular non-Hodgkin’s lymphoma. Clin Transl Oncol. 2015;17:1014-1019. 3. Freedman A. Follicular Lymphoma: 2018 Update on Diagnosis and Management. American Journal of Hematology. 2018;93:296-305.