Understanding Diagnostic Tests - …

1 11/9/20101 Understanding Diagnostic TestsSteven M. Horwitz AttendingLymphoma ServiceMemorial Sloan-Kettering Cancer CenterLymphomasDiagnosis and workup 2 of the most important initial questions What do you have? Where do you have it? Other important question What are you going to do about it?11/9/20102 LymphomasDiagnosis biopsy of suspicious lymph nodes or masses (extranodal) Routine histology Immunophenotyping CD2, CD3,CD4, CD5, CD7, CD8, CD20, CD30, CD56, etc11/9/20103 Large CellsSmall CellsFollicularDiffuseArchitecture11/9/2 0104 Types of Biopsies Fine needle aspirate (FNA) Core needle biopsy Surgical.

2 Incisional or excisionalTypes of BiopsiesFNAS mallest sampleBedside or hard to reachNo ArchitectureCoreHollow needleLess invasiveCT guidedSmall SampleSurgicalBest sampleMost informationMost tissueRequires an incision11/9/20105 Immunophenotyping Tells what kind of cell it is B cell vs T cell (CD whatever) Patterns of markers lead to diagnosisCD3CD20CD8CD10CD30CD5 ImmunohistochemistryAntigenAntibody Stain Enzyme-colorFluorescencePattern can lead to the diagnosis11/9/20106 DIFFUSE LARGE B CELL STUDIES SHOW THAT THE B CELLS ARE POSITIVE FOR CD20 AND HIGH PROLIFERATIVE RATED iffuseLargeCD20Ki-67 BCL2+Ki-67 10%CD20+CD10+FOLLICULAR LYMPHOMA: IMMUNOHISTOCHEMICAL STUDIES DEMONSTRATES NEOPLASTIC CELLS TO BE POSITIVEFOR CD20, CD10, BCL2.

3 THE PROLIFERATIVE INDEX WITH KI-67 IS 10%. 11/9/20107CD20+CD5+CyclinD1+MANTLE CELL LYMPHOMAIMMUNOHISTOCHEMICAL STUDIES SHOW POSITIVE IMMUNOLABELING FORCD20, CYCLIN-D1, CD5. WHILE NEGATIVE FOR CD3, CD10. BCL2 ImmunohistochemistryCD30+CD15+CD20-CLASS ICAL HODGKIN'S LYMPHOMA, NODULAR SCLEROSIS STAINS FOR CD15 AND CD30 LABEL SCATTERED REED-STERNBERG CELLS , CD 20 IS NEGATIVE11/9/20108 LymphomasDiagnosis and workup 2 of the most important initial questions What do you have? Where do you have it? Staging CT scan PET scan Bone Marrow BiopsyCT ScanOral contrastIV contrast11/9/20109CT ScanCT Scan: Axillary (under the arms) Lymph NodesSize (enlarged lymph nodes) and masses11/9/201010CT Scan, Before and AfterEnlarged lymph nodes under right armsComplete remission after chemotherapy.

4 PET (CT) ScanOral contrastIV contrast-Sometimes11/9/201011 PET (CT) ScanMetabolic ActivityPET Shows areas with increased uptake of FDG: suggestive but not Diagnostic of some cancers including lymphomaPET (CT) Scan, Fusion ImagesSize (enlarged lymph nodes) and masses and increased metabolic activity11/9/201012 PET (CT) Scan, Fusion ImagesNodule in the lung seen on CT scan. PET fusion images show that is it metabolically active and therefore more likely to be cancer-this requires a biopsyPET (CT) Scan, Fusion ImagesBefore and AfterT-cell lymphoma with PET avid lymph nodes under arms and in chestComplete remission after chemotherapy.

5 PET activity in bones from and workup What do you have? biopsy Histology Immunohistochemistry Where do you have it? Staging Scans, CT and PET Bone marrow