Staging and Evaluation of the Patient with Lymphoma
Section snippets
Pretreatment evaluation
Patients with non-Hodgkin's lymphoma (NHL) or Hodgkin's lymphoma (HL) most often present for medical attention because of signs or symptoms referable to enlarged lymph nodes or other disease-related symptoms, such as fevers, night sweats, or fatigue. They less often present with secondary effects of lymphoma on critical organs, such as bone marrow, lung, liver, spleen, or kidneys. Because of the nonspecific nature of these findings, months may elapse before the diagnosis of lymphoma is
Response assessment
In the absence of effective therapies, assessment of response is almost irrelevant. However, as an increasing number of effective treatments become available, standardized measures of evaluation become critical.
Prior to 1999, the lack of standardized measures led to variability among clinical trials groups and cancer centers in how response to therapy was evaluated and, thus, impeded comparisons of study results. Response was sometimes assessed prospectively, other times retrospectively, with
Recommendations for the use of PET in clinical trials
The clinical use of FDG-PET has far exceeded the validation of this technology in clinical trials. Juweid and colleagues22 were the first to integrate PET into the IWG criteria in NHL. PET not only increased the number of complete remissions in patients with diffuse large B-cell NHL, but it eliminated CRus, and provided a better separation of the progression-free survival curves between CR and partial remission (PR) patients. This information, along with the increasing availability of FDG-PET,
Follow-up evaluation
The most important components of monitoring patients following treatment are a careful history and physical examination along with complete blood count and serum chemistries, including LDH and other relevant blood tests. Recently, the National Comprehensive Cancer Network published recommendations for follow-up of patients with Hodgkin's and non-Hodgkin's lymphoma:55, 56 for patients with Hodgkin's lymphoma in an initial complete remission, follow-up should include an interim history and
Issues with PET(/CT)
A number of important limitations of PET remained to be resolved. Differences in equipment, technique, and variability in interpretation among readers impairs comparisons among studies. Newer technology, such as PET/CT, makes comparisons with older data difficult. Histologic subtypes also differ in FDG-avidity.13, 63, 64, 65, 66 Moreover, there are many common causes of false-positive and false-negative PET scans.22, 28, 51, 67 In addition, the usefulness of PET in clinical trials requires
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B-cell neoplasms and Hodgkin lymphoma in the spleen
2021, Seminars in Diagnostic PathologyCitation Excerpt :Although tumor involvement usually results in palpable splenomegaly, approximately one third of nonpalpable spleens are involved by lymphoma at staging laparotomy.5 Currently, staging laparotomy has been replaced by imaging studies; positron emission tomography, in particular, allows for an accurate determination.6 Three major patterns of splenic B-cell lymphoma are recognized based on involvement of white pulp, red pulp, or more focal lesions.
Oncology
2014, Acute Care Handbook for Physical Therapists: Fourth EditionComparison of PET-CT and magnetic resonance diffusion weighted imaging with body suppression (DWIBS) for initial staging of malignant lymphomas
2013, European Journal of RadiologyCitation Excerpt :The two readers analyzed in consensus on whether a lymph node region or an organ was involved (i.e. positive or negative). Lymph node involvement was considered as positive according to two criteria: (1) size: according to IWG (international working group) criteria [10], a lymph node larger than 10 mm in its longest transverse diameter was considered positive for lymphoma involvement, except for those with a clearly identified fatty hilum and thin cortex; (2) DWIBS analysis: for 16 regions (cervical, supraclavicular, internal mammary and diaphragmatic, anterior mediastinal, paratracheal, hilar, subcarinal and posterior mediastinal, celiac and superior mesenteric, hepatic and splenic hilar, retroperitoneal and periaortic, inferior mesenteric lymph nodes), signal intensity was visually assessed. For 2 regions, axillary and femoral, the cut-off size was 15 mm.
Extranodal non-hodgkin lymphomas of the oral cavity and maxillofacial region: A clinical study of 58 cases and review of the literature
2012, Journal of Oral and Maxillofacial SurgeryCitation Excerpt :Stage IV refers to the presence of diffusion or involvement in the spreading of 1 or more extralymphatic organs with or without associated lymph node involvement. The presence or absence of systemic symptoms should be noted with each stage designation (where A indicates asymptomatic and B indicates the presence of systemic symptoms, such as fever, sweating, and weight loss >10% of body weight).28 Extranodal DLBCL is a disease of older men, with a median age in the seventh decade,4,29 as found in most of the patients in our study (Table 1), who were aged older than 40 years, whereas only 1 patient was aged 25 years (patient 6).
How I treat: Diagnosing and managing "in situ" lymphoma
2011, BloodCitation Excerpt :Nonetheless, the patterns of presentation as well as of evolution seem to be more strictly related to the counterpart MCL with a more extensive presentation and a more aggressive behavior. Determination of disease extent by staging workup is of major concern in malignant lymphoma providing pretreatment risk assessment, adequate treatment planning, and appropriate evaluation of therapeutic results.34-36 Several staging systems and prognostic scores have been proposed and are worldwide accepted for the different lymphoma histotypes35,36 However, the staging procedures for “in situ” lymphoma are not defined, and a proposal can be only speculative in the absence of clear guidelines.
An Unusual Presentation of Follicular Lymphoma
2011, Archivos de Bronconeumologia