Is pathological diagnosis necessary before treatment of lymphoma? Pathological diagnosis is the “gold standard” for the diagnosis of lymphoma, which means that accurate pathological diagnosis is a prerequisite for standardized diagnosis and treatment. Therefore, in general, pathological diagnosis is required before treatment. First of all, as you can see from my previous article, there are many different classifications of lymphoma, and the degree of malignancy is completely different, and the treatment plan for different lymphomas may be completely different. Secondly, in some cases, lymphoma has very similar clinical manifestations to many diseases such as autoimmune diseases, viral infections and even tuberculosis, but the treatment is completely different, and it is necessary to obtain a pathological diagnosis in order to provide targeted treatment. After all, most lymphomas require chemotherapy or radiotherapy to treat them, and both radiotherapy and chemotherapy have some side effects on the organism, and if a benign disease is misdiagnosed as lymphoma, the psychological and physical damage to the patient is greater. Only in extremely difficult and life-threatening cases, and with the full understanding of the patient and family, is it possible to provide some treatment for lymphoma in patients who “look alike but have no pathological diagnosis”. In most cases, treatment will only be initiated after a definitive pathological diagnosis is obtained. What is the procedure for taking a biopsy specimen? Is there a big difference between hospitals? Biopsy specimen retrieval is the operation that needs to be performed to obtain a specimen in order to obtain a pathological diagnosis. Sometimes it is a minor outpatient operation, sometimes it is a major operation with open abdomen, open chest or even open skull, and sometimes it requires ultrasound-guided puncture, sometimes thoracoscopy, laparoscopy, etc. Why is this? It is all for accurate diagnosis, and our aim is to take the approach that causes the least damage to the patient to obtain enough specimens for pathological diagnosis. However, some patients have fever and enlarged lymph nodes with wasting and night sweats, which clinically resemble lymphoma. However, the tissue taken for pathological diagnosis is found to be reactive hyperplasia, how does this happen? This is because some of the enlarged lymph nodes in some lymphoma patients are lymphoma and some are caused by inflammation secondary to lymphoma, and the lymph nodes taken by biopsy happen to be inflammatory, which is reactive hyperplasia at this time. At this time, the doctor may ask the patient to take another tissue biopsy, and some patients are even finally diagnosed with lymphoma after five or six tissue biopsies have been performed. The pathological diagnosis of lymphoma is a difficult one, so for the pathological diagnosis of lymphoma, doctors want to obtain as much intact lymphatic tissue as possible, and try not to take tissue by puncture. Because the tissue removed by puncture is often too small, it is likely that no diseased cells will be found. In general, the pathological specimen obtained by puncture with either a coarse or a fine needle is usually insufficient for the pathological diagnosis of lymphoma. However, in some isolated cases, tissue cannot be obtained from superficial lymph nodes and puncture is performed as a last resort because the physician cannot endanger the patient’s life to obtain pathological tissue. Therefore, we would like to take as much biopsy tissue as possible to help the accuracy of the pathological diagnosis, while ensuring patient safety. For superficially enlarged lymph nodes, it is relatively easy to take the specimen, and the surgeon can take it after feeling and gently everything. However, for deep lymph nodes, such as those in the chest and intestine, thoracoscopy, laparoscopy or surgery may need to be applied. In addition, for special types of lymphoma, such as nasal NK/T-cell lymphoma, where the lesions are located in the nasal cavity and sinuses, special methods are needed to take the specimens by ENT doctors. These special types of lymphoma are relatively difficult to obtain specimens from, because of the limitation of technical ability, and there is a certain difference in the ability of different hospitals to obtain specimens from certain special sites. After the specimen is taken locally, can the patient send the specimen to a large hospital such as Beijing for pathological diagnosis? No. Patients can borrow pathological sections of specimens from the pathology department of their local hospital. Generally, pathology slides are divided into unstained white slides and stained slides. It is best to borrow a few of each type of section to facilitate the pathologist’s diagnosis. Secondly, the patient or family should ask the doctor of the local hospital to write a brief case, introducing the medical history and relevant tests, especially the results of peripheral blood, bone marrow and ultrasound, or PETCT, etc., so that the diagnosis can be made by comprehensive analysis. What tests are needed to confirm the diagnosis of lymphoma other than pathological diagnosis? First of all, the pathological diagnosis is the first part, and the specialist who sees the patient must approve the pathological diagnosis before he/she can give appropriate treatment recommendations. Secondly, after the pathological diagnosis is clear, the diagnosis of lymphoma does not end there, the doctor has to clarify the stage of lymphoma. PET-CT, bone marrow aspiration, and basic tests such as liver and kidney function are usually required. PET-CT is more important and relatively more accurate for the staging of lymphoma, but it is also relatively expensive, usually around 10,000 RMB. For patients who can afford it, it is better to have PET-CT, but for those who cannot have PET-CT for financial reasons, they can also have general CT of the chest, abdomen, pelvis, etc., and head MRI, etc. Bone marrow aspiration is also a mandatory test for doctors to check whether the lymphoma has invaded the bone marrow. Lumbar puncture is sometimes done as well. Certain patients and certain lymphomas are particularly prone to invade the center, and these patients may need lumbar puncture to rule out lymphoma invasion of the center. In addition, before lymphoma treatment, the function of the patient’s basic organs, such as the heart, lungs, liver and kidneys, must be evaluated to prepare for the next step of treatment.