For lymphoma diagnosis, a multimodality additive approach, which consists of history taking, clinical examination, laboratory parameters, histopathological findings, genetic findings, and static or functional (e.g., PET-CT, spectroscopy) imaging, is essential.
In this issue of InFo ONCOLOGY & HEMATOLOGY, both an interesting case report on the unexpected finding of primary central nervous system lymphoma in a young neurofibromatosis type 1 patient with progressive hemiparesis and the update for daily practice on nodal lymphomas illustrate the importance of integrative lymphoma diagnostics for the correct choice of an adequate therapy for the specific entity and for the concrete patient.
Tissue-based diagnostics are indispensable in lymphomas, as histopathological changes form the cornerstone for determining dignity. In addition to the pure determination of dignity, the histopathological findings also play an important role, since the determination of specific lymphomentities is nowadays essential for adequate therapy.
Clinical presentation and anamnestic context provide important information for correct diagnosis in certain entities (see Update for Daily Practice), elicit important prognostic factors (e.g., B symptoms), or may limit therapeutic options (e.g., limited applicability of anthracyclines in existing heart disease).
The progress of imaging techniques is reflected not only in the development of punch biopsy techniques, which have a broader application and meanwhile allow entity-specific information in approximately 85% of the needle biopsies sent, while at the same time reducing patient burden, but and above all in functional diagnostics, which has proven to be an important dynamic method for monitoring the success of therapy far beyond staging.
Recent data suggest that (entity-)specific genetic alterations not only play a role in diagnosis, but may also predict sensitivity to targeted therapies such as ibrutinib, obatoclax, or everolimus.
With this in mind, I wish you an exciting read!
Prof. Dr. med. Alexandar Tzankov
InFo Oncology & Hematology 2014; 2(2): 4.
