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Follicular lymphoma is diagnosed through a series of tests that examine the blood, lymph nodes and bone marrow. The process usually begins with a physical examination where the doctor checks for physical signs of follicular lymphoma such as enlarged lymph nodes, spleen, and liver. If follicular lymphoma is suspected, the following tests may be conducted:

Blood Tests:

  • Complete blood count (CBC): This test measures the amount of different types of blood cells in a sample of your blood. People with follicular lymphoma often have too many lymphocytes, a type of white blood cell.
  • Blood chemistry tests: These tests measure the levels of certain substances in your blood that can indicate how well your organs like your liver and kidneys are functioning and whether the lymphoma is affecting your body's chemistry. 
  • Lactate dehydrogenase (LDH) test: When cells break down, they release a chemical called LDH. If you have follicular lymphoma, you can have more LDH in your body because more cells are being produced and broken down. Looking at LDH levels can tell doctors how advanced the lymphoma might be.

Lymph Node Tests:

  • Lymph node biopsy: This is a test where all or part of an enlarged lymph node is removed under local or general anesthesia, and the cells are examined under a microscope. This can be done with ultrasound or CT guidance or sometimes may require a surgical excisional biopsy. A biopsy is the only way to confirm a follicular lymphoma diagnosis.
  • Immunohistochemistry: A test that assesses for certain proteins on the surface and inside of cells. Follicular lymphoma ha a signature pattern of proteins including CD10, CD20 and BCL62. At the same time, these cells usually do not have the CD5 and CD43 proteins.

Bone Marrow Tests:

  • Bone marrow aspiration and biopsy: This test involves taking a small amount of bone marrow from your hipbone and examining it under a microscope to look for lymphoma cells. Bone marrow biopsies for diagnosing follicular lymphoma are controversial. This test has been a part of traditional diagnostic practices for many years but more recently, experts have started to agree that bone marrow biopsies may not be beneficial for patients. Many experts believe it should be eliminated as standard practice as a PET scan might be good enough to identify the presence of follicular lymphoma in both the blood and bone marrow. 
  • Cytogenetic analysis: This test looks at the chromosomes of cells from samples of blood, bone marrow, or lymph nodes to see if certain changes are present that can suggest follicular lymphoma.
  • Flow cytometry: This test is used to measure the number of cells in a sample and can identify different types of cells based on their size, shape, and the presence of certain markers on their surface.

Imaging Tests:

  • Computed Tomography (CT) scan: This test can help to determine the location and size of the lymphoma in the body.
  • Positron Emission Tomography (PET) scan: This test can help to determine if the lymphoma is active and how it is responding to treatment.
  • Magnetic Resonance Imaging (MRI): This test can help to determine the extent of the lymphoma and whether it has spread to the brain or spinal cord.

A Summary of Diagnosing Follicular Lymphoma

It's important to note that the diagnosis and classification of follicular lymphoma is complex and requires a comprehensive evaluation by a team of specialists. If you don't currently have a follicular lymphoma specialist on your team, it is important that you consult with one. Use HealthTree's Follicular Lymphoma Specialist Directory to locate a specialist near you. 

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