Diagnosing Non-Hodgkin Lymphoma

Support Throughout the Diagnostic Process

Our physicians, nurses and support staff are here to advise you, listen to you and calm your fears. Your physicians will explain your diagnosis and compassionately offer suggestions for treatment and care. Their job is to help you.

Also available for counsel, support and guidance are nurse coordinators, oncology social workers and a pastoral team. They’ll help you navigate through the system and provide additional assistance, including:

  • Social support
  • Spiritual guidance
  • Emotional support
  • Practical advice
  • Tips on coping

Call on them. They’re here for you.

Lymphomas are complex blood disorders. Especially non-Hodgkin lymphoma. It takes a team of highly trained specialists to accurately diagnose, evaluate and classify it in order to properly and effectively treat it.

Advanced training and skill are the hallmarks of your Scott & White Lymphoma Team. We’ve assembled a preeminent group of dedicated hematologist/oncologists who specialize in disorders and malignancies of the blood. They’re highly experienced in diagnosing and treating all types of lymphomas.

Your team of hematologist/oncologists, hepatopathologists and cytogeneticists employ the most progressive diagnostic procedure available to diagnose and classify your non-Hodgkin lymphoma with meticulous precision.

To me the team care of the patient has to begin with who the most important team member is—and that’s the patient. We are truly centered around the patient.

Christian T. Cable, Medical Oncology; Director, Blood & Marrow Transplant Program

Diagnostic Excellence and Precision

Our blood disorder specialists have an unparalleled breadth and depth of knowledge and experience in diagnosing non-Hodgkin lymphoma. They’re expert in identifying and isolating its many subtypes.

Of special note are our hematopathologists, physicians who specialize in diagnosing diseases of the blood, bone marrow and lymph system. Our pathology team is superb at analyzing:

  • Bone marrow biopsies
  • Blood smears
  • Lymph node biopsies

They provide necessary information regarding the progression and prognosis of your non-Hodgkin lymphoma for your treatment team.

Our cytogeneticists are acclaimed at studying chromosomes and chromosomal abnormalities in order to diagnose non-Hodgkin lymphoma and determine subtype. Like hematopathologists, they’re key members of your Integrated Care Team, providing vital information for treatment planning.

Our hepatopathologists and cytogenetics group are invaluable to us in helping us figure out what specific features are there in this leukemic cell that can predict for how you’re going to do.

Mark H. Holguin, MD, Hematology/Oncology; Chief – Section of Hematology

Once the team has determined your subtype of non-Hodgkin lymphoma, your physician will discuss with you:

  • What subtype of non-Hodgkin lymphoma you have
  • How your non-Hodgkin lymphoma will likely progress
  • What your chances of remission or cure are
  • What your treatment will be like
  • The side effects of your treatment
  • The emotional aspects of dealing with lymphoma

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Non-Hodgkin Lymphoma Diagnostic Services

Physical Exams

  • Physical exam and history. Your physician will begin with a thorough physical exam and medical history. Your physician will examine you for:
    • Enlarged lymph nodes or spleen
    • Signs of infection or injury
    • Signs of tumors
  • Esophagogastroduodenoscopy (EGD). Your physician may order this test if your disease affects your digestive tract.
  • Lumbar puncture. Your physician may order this test if your disease affects your central nervous system.


A biopsy is generally the best way to confirm the presence of non-Hodgkin lymphoma. Your physician may order a biopsy if non-Hodgkin lymphoma is suspected based on the results of other diagnostic tests.

A biopsy is the surgical removal of a small sample of tissue. This tissue sample is sent to the laboratory for evaluation by a pathologist

  • Excisional lymph node biopsy. In this procedure, your surgeon will make a small incision and remove the entire lymph node.
  • Incisional lymph node biopsy. In this procedure, your surgeon will make a small incision and remove only a part of the enlarged lymph node.
  • Fine needle aspiration. In this procedure, your surgeon will insert a very thin needle through your skin and into your lymph node. With the needle, your surgeon will remove a small sample of fluid containing tiny bits of tissue.
  • Bone marrow aspiration. Bone marrow aspiration is the removal of a small amount of tissue in liquid form for examination. Bone marrow is found in the hollow part of most bones. It helps form blood cells.    
  • Bone marrow biopsy.  A bone marrow biopsy is the surgical removal of a small sample of soft tissue, called marrow, from inside bone. Bone marrow is found in the hollow part of most bones. It helps form blood cells.

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Lymphomas are determined by biopsy. We have to take a sample of an enlarged lymph node somewhere, because that’s where lymphomas tend to grow, so that we can look at it under the microscope.

Mark H. Holguin, MD, Hematology/Oncology; Chief – Section of Hematology

Laboratory Tests

Your pathologist will use samples procured at biopsy to determine:

  • Whether you have non-Hodgkin lymphoma
  • The subtype of non-Hodgkin lymphoma you have
  • Your treatment plan

Your pathologist may conduct one or more of the following advanced laboratory tests:

  • Immunophenotyping. This test can confirm an NHL diagnosis by identifying the presence of B-cells.
  • Cytogenetic analysis. This test identifies gene changes in chromosomes.
  • Gene expression profiling & microarray analysis. These genetic tests can help identify your NHL subtype and risk factors and whether you may relapse more easily.
  • Fluorescent in site hybridization (FISH). This type of genetic analysis is used to identify specific changes within chromosomes. Your physician may order this test to help identify whether you carry a particular gene change.
  • Polymerase chain reaction. This highly precise genetic test is used to find chromosome changes too small to be identified under a microscope. A benefit of this test is that only a tiny sample of cells is required. It can also help predict your response to treatment.

Chromosomal studies help us define specific subsets of lymphomas.

Mark H. Holguin, MD, Hematology/Oncology; Chief – Section of Hematology

Blood Tests

There are a number of blood tests your physician may order to help determine treatment options for your NHL.

  • Complete blood count. This test is used to determine the number of red blood cells, white blood cells and platelets you have.
  • B-cell leukemia/lymphoma panel. Certain proteins serve as markers that may be helpful in diagnosing lymphoma.
  • Blood differential. This test checks for abnormalities or deficiencies in your lymphocytes.
  • Peripheral blood smear. This test helps determine the condition and levels of your red blood cells, white blood cells and platelets.
  • Blood protein levels. Elevated levels of certain proteins may indicate disease.
  • Uric acid level. Elevated levels of uric acid may indicate disease.
  • Liver function test. This test measures certain substances in your blood produced by your liver; elevated levels may indicate disease.
  • Erythrocyte sedimentation rate. This test checks the speed at which your red blood cells settle at the bottom of a test tube; rapid rates may indicate cancer.
  • Lactate dehydrogenase (LDH). This test measures tissue damage.
  • Beta 2-microglobulin. Elevated levels may indicate disease.

Imaging Tests

If you have a positive diagnosis of non-Hodgkin lymphoma, your physician team may order one or more of the following imaging studies to check for signs of disease and to determine whether your non-Hodgkin lymphoma has spread to other areas of your body.

  • Ultrasound
  • Computed tomography (CT) scan
  • Magnetic resonance imaging (MRI) scan
  • Positron emission tomography (PET) scan
  • Fluorodeoxyglucose PET (FDG-PET) scan
  • Chest X-ray
  • Bone scan

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