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Ancillary Testing in Lymphoma Diagnosis and the Challenges of Small Biopsies

 

Although the diagnosis and classification of lymphomas is highly dependent of morphology, some degree of ancillary testing is necessary in almost every case. Immunophenotyping is typically performed to assign or confirm lineage as well as to demonstrate the expected immunophenotype of the diagnosis. In some cases, an immunostain can serve as a surrogate marker for a recurrent genetic abnormality. Cytogenetic and genetic testing can also contribute to lymphoma diagnosis, and FISH testing in particular can identify specific entities and provide prognostic information. Genomic studies such as NGS do not yet play a significant role in lymphoma diagnosis, but a future increasing role is likely. This presentation will discuss the role of ancillary testing in lymphoma diagnosis and highlight a few entities where additional testing adds important information. The dependence of lymphoma diagnosis on morphology and particularly architecture leads to inherent challenges in making a specific diagnosis on needle core specimens. This presentation will also address some important caveats on this topic.

Originally presented on February 13, 2020, in Park City, Utah.

Lecture Presenter

Rodney R. Miles, MD, PhD

Rodney R. Miles, MD, PhD

Associate Professor of Pathology
University of Utah School of Medicine
Section Chief, Hematopathology; Medical Director, Hematologic Flow Cytometry; Medical Director, Immunohistochemistry Laboratory; Medical Director, Histology Laboratory
ARUP Laboratories

Dr. Miles is the Section Chief of Hematopathology at ARUP Laboratories and an associate professor of pathology at the University of Utah School of Medicine. Dr. Miles received his MD and a PhD in cell biology from the University of Nebraska. He is certified by the American Board of Pathology in anatomic and clinical pathology, with subspecialty certification in hematology. His research interests include pediatric non-Hodgkin lymphoma and acute lymphoblastic leukemia.

Dr. Miles is a member of the American Society of Hematology, the Society for Hematopathology, and the United States and Canadian Academy of Pathology. He is a member of the Children's Oncology Group non-Hodgkin lymphoma committee and serves as a central pathology reviewer for clinical trials.

Objectives

After this presentation, participants will be able to:

  • Recognize the utility and necessity of ancillary testing in the diagnosis of lymphoma
  • Discuss the use of FISH assays to provide prognostic information or precise classification in lymphoma diagnosis
  • Describe the challenges and perils of small biopsies in lymphoma diagnosis

Sponsored by:

University of Utah School of Medicine, Department of Pathology, and ARUP Laboratories