3.2 Prognostic assessment

3.2 Prognostic assessment

Staging is a critical element in treatment planning and should be clearly documented in the patient’s medical record.

A number of lymphoma prognostic indices have been developed for the different low-grade lymphoma entities and are documented in the relevant guidelines (BSH 2020; Cheah et al., 2019; Dreyling et al. 2017; 2020). It is appropriate to document the relevant low-grade lymphoma prognostic indices at diagnosis, which may assist in the therapeutic approach.

The disease stage based on the 2014 Lugano classification (Cheson 2014) should be determined in all patients according to evidence-based guidelines.

Staging and prognostic assessment for low-grade lymphomas involves the following:

  • Clinical examination and history for assessment of B It is particularly important to document the sites and extent of FL involvement that are not easily visible on imaging (e.g. skin, conjunctiva)
  • Imaging with PET-CT should be performed for the staging of indolent lymphomas, in particular FL and PET-CT has greater sensitivity than CT in detecting nodal and extranodal involvement and is valuable in identifying true stage I disease amenable to radiation therapy.

Some cases of MZL exhibit low positivity on PET-CT scanning and in these instances subsequent imaging with CT may be preferable

  • The decision to do a bone marrow biopsy should be according to evidence-based guidelines for the specific A bone marrow aspirate and trephine is an element of complete staging of most low-grade lymphomas. However, it may not be necessary at diagnosis where the planned initial approach is watch and wait, nor before starting treatment if the results before and/or after treatment will not impact on prognosis or therapeutic approach. The purpose of the bone marrow biopsy should be clearly explained to the patient, especially when performed in a clinical trial where it may not otherwise have been indicated
  • For MCL, symptoms that suggest gastrointestinal involvement should be investigated with gastroscopy and colonoscopy
  • Endoscopic ultrasound for gastric MZL can be used to characterise gastric wall infiltration and peri-gastric lymph node involvement
  • MRI imaging is of value in orbital/ocular adnexa MZL
  • Additional tests are recommended to calculate the relevant prognostic scores for each low-grade